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23 tow* 





fi&vsQiscL iliB UK's most stylish pha 

1 pu^2E3 



Test your MUR skills with our case studies 


Six steps to dealing with accidents at work 



Making lives better 

We are committed to improving our 
products and services by working in 
partnership with you, our customer. 

We are not a standard company, 
the reference others aspire to be 

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Fexofenadine Hydrochloride 
Telfast 120mg film-coated tablets 

The tablets are film-coaled peach coloured tablets containing 120 mg 
fexofenadine hydrochloride, equivalent to 112 mg ol fexofenadine 

For reliel of symptoms associated with seasonal allergic rhinitis. 
Dosage & Administration: 

For Ihe treatment ol seasonal allergic rhinitis in adults and children aged 
12 years and over, the recommended dose of fexofenadine hydrochloride 
is 120 mg once daily before a meal The efficacy and safety of fexofenadine 
hydrochloride has not been established in children under 6 years of age. 


Known hypersensitivity to any ol Ihe products ingredients. 

Studies in adults have shown lhal it is not necessary to adjust the dose of 
fexofenadine hydrochloride in the elderly or in renally or hepalicaily 
impaired patients. However, fexotenadine should be administered with 
care in these special groups. 

Side effects (Please refer to the Summary of Product 
Characteristics for full side-effect details): 

In controlled clinical trials the incidence ol commonly reported adverse 
events observed with fexofenadine was similar to fhal observed with 
placebo. These adverse events were headache, drowsiness, nausea, 
dizziness, and sleep disorders or paroniria, such as nightmares. In rare 

cases rash, hypersensitivity reactions with manifestations such as 
angioedema, chesl lightness, dyspnoea, and systemic anaphylaxis have 
also been reported. 
Pregnancy & Lactation: 

Fexofenadine is not recommended in pregnancy or lor mothers breast- 
feeding their babies, due to absence of experience in this group of patienls. 
Legal Category: POM 

Marketing Authorisation Number: PL 04425/0157 
NHS Price: Pack of 30 Tablets: £ 6.23 
Further information is available from Winlhrop Pharmaceuticals, 
One Onslow Street, Guildford, Surrey, GU1 4YS. 

Date of Revision of Prescribing Information: April 2009 



Economise without compromise 

Adverse events should be reported and information about adverse event reporting can be found on 
Adverse events should also be reported to Winthrop Pharmaceutical UK Ltd as follows:- Email: Tel. 01483 554242 Fax.:01483 554806 

For further information please visit our website www., freephone 0800 854431 or contact Winthrop Pharmaceuticals, 1 Onslow Street, Guildford, Surrey, GU1 4YS. Fax number 01483 554831 Date of Preparation April 2009 SJW374 

Have your say 

Croup Editor 

Gary Paragpuri MRPharmS 
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firstname. surname 


A decade ago Tony Blair famously 
promised us 'education, education, 
education'. This week David Cameron 
and Nick Clegg revealed their 
political aspirations under the slogan 
'Freedom. Fairer. Responsibility'. 

In a 36-page document setting 
out the government's planned 
programme of action, the Cameron- 
Clegg partnership promises us "era- 
changing, convention-challenging 
radical reform" and a commitment 
to "turning old thinking on its head". 

If it was down to creative and 
inspiring language, Dave and Nick 
win hands down, but it's action and 
results that count, not rhetoric. 

Under Labour, GPs increased their 
stranglehold on primary care and 
were handsomely rewarded through 
their quality and outcome 
framework and as they took greater 
control of commissioning services. 

Under the new coalition, it 
appears to be more of the same. 
The new health secretary talks 
of devolving power to CPs and 
getting them to take on greater 
responsibility for commissioning 
services. The difference is to give 
patients a "stronger voice" through 
elected people on PCT boards (p4). 

Quite where all this leaves 
community pharmacy - arguably the 
most accessible and efficient 
healthcare provider of all - is 
unclear. There's been precious little 
mention of pharmacy's role in long- 
term conditions or public health - 
actually, there's been zero mention 

of pharmacy's role in any of the 
government's health policy 
documents. Hopefully we can put 
this down to 'early days' in the new 
administration - pharmacy is 
perhaps not the biggest fish in the 
sea to be fair. 

At least the minister with 
responsibility for pharmacy has been 
announced and his appointment 
welcomed (p4). Nonetheless, it's 
imperative that community 
pharmacy seizes the initiative. We 
will see a new health bill, and 
primary care services will see more 
upheaval. But community pharmacy 
has a good story to tell - it's 
efficient, accessible, trusted and able 
to turn ideas into practice. 

There's a window of opportunity 
now for pharmacy to let the powers 
that be know it can help "turn old 
thinking on its head" and the sector's 
lead organisations need to work 
quickly before it shuts. 

Elizabeth Lee - the case continues 
Elizabeth Lee, the locum given a 
suspended two-year jail sentence 
last year for a dispensing error, has 
had her sentence reduced to a fine 
(p4). While every pharmacist will 
welcome this news, as C+D went to 
press her conviction still stood and 
we still await guidance from the 
Crown Prosecution Service on 
decriminalising dispensing errors. 
One step at a time. 

Gary Paragpuri, Editor 

4 New pharmacy minister named 

5 GPhC in fee consultation 

6 Errors in prescription pricing continue 
8 Boards to tackle workplace pressure 
10 Where next for the APPG? 

12 Product and market news 
14 Xrayserand Nick Barber 
28 Classified 
34 Postscript 

17 Update: MUR case studies 

Concerning diabetes and heart failure 

19 Practical Approach 

Which antihypertensive? 

20 Ethical Dilemma 

A prescription from Europe - should you dispense? 

22 Health and wellbeing 

Dealing with accidents at work 

26 Platinum Design Awards 

Revealed: the UK's most stylish pharmacies 

26 Careers 

Away days can do wonders for your career 

© UBM Medica, Chemist + Druggist incorporating Retail Chemist, Pharmacy Update and Beauty Counter. Published Saturdays by UBM Medica, Ludgate House, 245 Blackfriars Road, London SE 1 9UY. C+D online at. Subscriptions: With C+D Monthly pricelist £250 (UK), without pricelist £205 (UK). ROW price £365. Circulation and subscription: UBM Information Ltd, Tower House, Sovereign Park, Lathkill St, 
Market Harborough, Leics. LE16 9EF Telephone: 01858 438809 Fax: 01858 434958. Refunds on cancelled subscriptions will only be provided at the publisher's discretion, unless specifically guaranteed within the terms of 
subscription offer. The editorial photos used are courtesy of the suppliers whose products they feature. We are not responsible for the content of any external websites referred to in this magazine All rights reserved No part of 
this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical including photocopying, recording or any information storage or retrieval system without the express prior written consent 
of the publisher. The contents of Chemist+Druggist are subject to reproduction in information storage and retrieval systems. UBM Information Ltd may pass suitable reader addresses to other relevant suppliers. If you do not wish 
to receive sales information from other companies please write to Emily Miles at UBM Medica Origination by ITM Publishing Services, Central House, 142 Central St, London EC1V 8AR Printed by Headley Brothers Ltd, The Invicta 
Press, Queens Road, Ashford TN24 8HH. Registered at the Post Office as a Newspaper. Volume 273 No 6749 




ew pharmacy minister: plans 
for sector due in 'coming months 1 

Earl Howe has a strong track record in the sector, say pharmacy bodies 

Earl Howe: enthusiastic about 
pharmacy's rote 

Chris Chapman 

Earl Howe, a hereditary peer, has 
been named as the minister 
responsible for pharmacy in England 
and said the sector's future will be 
outlined in the "coming months". 

Earl Howe will serve as 
parliamentary under secretary of 
state for quality, with his portfolio 
including primary care, finance, NHS 
commissioning reform and 
medicines, pharmacy and industry. 

His appointment was welcomed 
by pharmacy bodies who said his 
track record had proven him to be a 
strong representative for the sector. 

Earl Howe told C+D he believed 
pharmacists would be at the 
vanguard of preventative medicine 
in the coming years. 

He said: "I am very enthusiastic 

about how pharmacy will play a 
bigger role in improving the lives of 
people, especially in ensuring the 
safe and effective use of medicines. 

"We want people to have more 
control over their health and 
pharmacists are vital in our focus on 

PSNC chief executive Sue Sharpe 
said the committee had worked with 
Earl Howe on a number of issues in 
recent years and was "confident that 
he will be a strong advocate for 
community pharmacy within the 
Department of Health". He fully 
recognised pharmacy's capacity to 
expand the range of services it 
provided, Mrs Sharpe added. 

NPA director of communications 
Nicola Rossi also welcomed the 
appointment, describing Earl Howe's 
"keen interest" in community 
pharmacy as "encouraging". 

Prior to joining the Department 
of Health team, Earl Howe, who 
inherited his title in 1984, was 
opposition spokesperson for 
health and social services in the 
House of Lords. 

In June 2009, he campaigned for 
the decriminalisation of single 
dispensing errors following the 
conviction of Elizabeth Lee. He 
said: "Does the existence of a 
strict criminal liability test enhance 
public safety? If the answer is no, 
as I believe, then the law needs to 
be changed." 

In the aftermath of the 
general election, the 
APPG needs your MP 

See analysis, plO 

Elizabeth Lee overturns Government unveils 
jail sentence for error NHS blueprint 

Elizabeth Lee has overturned the 
suspended jail sentence she received 
for a one-off dispensing error made 
while working as a locum forTesco 
in 2007. 

The Court of Appeal ruled Ms Lee's 
punishment should be reduced to 
a £300 fine as C+D went to press on 

However, the judges stopped 
short of overturning Ms Lee's 
criminal conviction for dispensing 
propranolol instead of prednisolone 
to an elderly cancer patient. 

Ms Lee voiced mixed feelings over 
the verdict. In a written statement, 
she said: "I am delighted the Court of 
Appeal has reduced my sentence... 
however, it is a great shame the 
Court of Appeal decided not to 
overturn my conviction." 

Ms Lee added the "tragic" events 
of the past three years would stay 
with her and "no doubt" the victim's 
family forever. 

Mark Koziol, PDA chairman and 
member of Ms Lee's legal team, said 
the appeal's success secured an 
important precedent for all 

pharmacists. Speaking exclusively to 
C+D outside the court in London, he 
said: "If any pharmacist finds 
themselves in a similar situation 
then judges will be told, don't use a 
custodial sentence." 

Mr Koziol added that he was 
disappointed that Ms Lee's 
conviction was not quashed. 

Ms Lee's case sparked strong 
sympathy among pharmacist 
colleagues and triggered an industry- 
wide campaign to decriminalise 
dispensing errors last year. 

Ms Lee thanked supporters for 
helping her through her "ordeal". 

She said: "I would like to extend a 
thank you to all those pharmacists 
that have wished me well. I now 
wish to finally put this tragic episode 
behind me." MC 

For more on the 
overturning of Elizabeth 
Lee's conviction go to: 

The coalition government has 
promised greater powers for GPs 
and patients in an NHS policy vision 
that leaves pharmacists in the dark 
over future prospects. 

Doctors will be free to directly 
commission services on behalf of 
patients under the terms of the 
health bill revealed in this week's 
Queen's speech. 

And PCTs will be charged with 
commissioning services "best 
undertaken at a wider level", 
according to a programme for 
government also unveiled by the 

But there was no mention 
of pharmacy in the health bill or 
the programme for government 
document and pharmacy's contract 
negotiator urged caution over 
the plans. 

"There's potential for concerns, 
but some of those might be 
alleviated by how this all fits 
together," said Alastair Buxton, 
PSNC's head of NHS services. "I 
don't think anybody knows the fine 
detail at the moment - this has been 

put together very rapidly." 

Extended GP commissioning 
powers would be a key worry for 
pharmacy, Mr Buxton stressed. 

He also predicted a culling of PCT 
numbers as the government set its 
sights on cutting the cost of 
administration by a third. 

PSNC had launched talks with the 
Department of Health on 
establishing pharmacy's role in 
government plans already, Mr 
Buxton revealed. 

However, discussions had been 
hindered by the embryonic status of 
the coalition, he said. 

Other standout proposals from 
the new government included 
creating an independent NHS board 
in charge of allocating health 
resources, incentivising ways of 
improving access to primary care 
in disadvantaged areas and 
publishing data on the performance 
of NHS providers. MC 

Seethe health bill and programme 
for government in full at: 



Get ail the latest community pharmacy news delivered to you 


GPhC proposes £262 fee 

Chief executive says profit 'not on the agenda' despite proposed fee rise 

Zoe Smeaton 

The General Pharmaceutical Council 
(GPhC) has launched a consultation 
into its fees for 2011, and defended 
the proposed renewal fees despite 
criticism from the RPSGB. 

The proposed renewal fee is 
£262 for pharmacists and £142 
for pharmacy technicians. The 
pharmacist fee and the professional 
leadership's body's fee of £192 come 
to a total of £454 - £32 more than 
the current RPSGB fee of £422. 

Steve Churton, president of the 
RPSGB, said he was disappointed 
that the GPhC had been unable to 
keep the total costs of regulation 
and professional leadership to 
within the current combined fee 
plus inflation. 

"It is true that any organisation 
going through a demerger is likely to 
lose some efficiency, but it is not 
clear why the total regulatory 
burden has increased so 
substantially," he said. 

But GPhC chief executive Duncan 
Rudkin said the GPhC had looked at 

September takeover for GPhC 

Chief executive Duncan Rudkin 
has defended the. news that the 
GPhC will not now fully take over 
the RPSGB's regulatory functions 
until the end of September this 
year. He told C+D: "The GPhC 
has been very careful to avoid 
speculation about a date so I don't 
think we're talking about a delay." 

Both organisations said they 
were confident the September 
date was "attainable" after 
constructive discussions involving 

the Department of Health. It had 
originally been expected that the 
GPhC might take over regulation 
as early as January 2010. Also 
RPSGB registrar Jeremy Holmes 
leaves the Society in July, Mr 
Rudkin will assume the role of 
registrar at the Society until the 
split is complete, but he confirmed 
that his employment remained 
with the GPhC despite the new 
accountability for RPSGB 
regulatory matters. 

i ; 0!; 

the RPSGB regulation budgets and 
costs as a way of cross-checking 
whether its own cost projections 
were reasonable and sensible 

He stressed that making a profit 
was "not on the agenda at all" for 
the GPhC. And he said although the 
regulator was looking to build up 
reserves, these were purely to enable 
it to meet any spikes in costs due to 
high demand or legal cases. 

"What we don't want to do is to 
be putting the fee up in a reactive 
and unplanned way and having it yo- 
yoing, which is bad for everybody in 
terms of planning and continuity," 
he said. 

Mr Rudkin also reassured 
pharmacists that the GPhC took its 
moral duty to set fees and ensure 
efficiency and cost-effectiveness 
"very seriously". "I recognise that 
paying fees is not something we all 
do with great joy but I would hope 
that people will be reassured that we 
will challenge ourselves, just as 
others will rightly challenge us, to 
continually improve the efficiency of 
what we do so that we're not racking 
up costs for the sake of it." 

Pharmacists have until August 16 
to comment on the consultation at 

i ii j . 
_ ««•»»» 


■ *«>■* 

!!5?! iJisi!i 

AAH fuel surcharge rise 

AAH's monthly fuel surcharge will 
rise to £10.75 from June 1, the 
wholesaler has announced. The 
group blamed a "significant 
increase in the cost of fuel in 
recent months". It follows an 
increase in January to £6.75. 

Boots Advantage Card 

Boots may open its Advantage 
Card scheme to other retailers, it 
has been reported. A spokesperson 
said the move was "a possibility 
for the future, but we are unable 
to comment further". 

Child constipation 

Nice has launched the first 
national evidence-based guide on 
the diagnosis and management of 
idiopathic constipation in children. 
C+D's guide to what you need to 
know about the recommendations 
is at www.chemistanddruggist. 

Rowlands mobility 

Rowlands is reviewing the 
business and service opportunities 
in supplying mobility aids through 
pharmacies after opening a 
specialist mobility and nursing 
store in Portsmouth. Commercial 
director John D'Arcy said: 
"[Mobility] is a growth area and 
you have got to say, 'Where does 
pharmacy fit into that?'." 

Allen Tweedie 

Colleagues have paid tribute to 
pharmacist Allen Tweedie, who 
died this week after succumbing 
to pancreatic cancer. Dr Tweedie 
was a fellow of the RPSGB, and 
was awarded the Society's Silver 
Medal in 2006 for his work for the 
community pharmacy sector. 
Funeral arrangements and 
donation suggestions are 
available at 


Murrays Healthcare's "art gallery-standard" Malvern branch (above) last week 
scooped the £3,000 first prize and Best Multiple Pharmacy Award at C+D's Platinum 
Design Awards 2010, in association with Ceuta Healthcare. Murrays MD Duncan 
Murray (right, with C+D editor Gary Paragpuri) and other representatives from 
winning and highly commended pharmacies were treated to a day at Lord's, 
collecting prizes in Marylebone Cricket Club's iconic media centre. See p26 for details 


Get the news every day with C+D newsletters 

Errors in prescription 
pricing still being made 

More compensation payments likely to be needed, says PSNC 

.. . nidation 

Boots has warned staff working at 
its Market Street, Manchester, 
store that they may have been 
exposed to contaminated water 
last Friday. The incident occurred 
after engineers working in the 
store accidentally introduced 
antifreeze into the water supply. 

BGMA chairman 
Michael Cann, commercial 
director at Actavis, was set to take 
up his position as chairman of the 
British Generic Manufacturers 
Association (BGMA) at the body's 
AGM as C+D went to press. Mr 
Cann takes over from Kim Innes of 
Teva, who will serve as vice-chair. 

Mothers' health 

The number of mothers smoking 
at childbirth has fallen to 14.1 per 
cent, down from 14.4 per cent 
compared with last year, the DH 
has said. Breastfeeding rates rose 
by 1 per cent compared with last 
year, reaching 72.7 per cent. 

Cai nbrlan Alliance 

Buying group Cambrian Alliance 
has appointed Duncan Heap as 
business manager for Scotland. 
Mr Heap would work with 
members to help them maximise 
profitability, the group said. 

Euro script difficulties 

Pharmacists must get a simpler 
system for checking prescriptions 
written outside the UK, a legal 
firm has warned. Existing guidance 
was impractical and time 
consuming, said Charles Russell. 

Zoe Smeaton 

zoe. smea 

Pharmacies are still not being paid 
correctly by NHS Prescription 
Services and are likely to require 
more compensation payments in the 
future, PSNC has warned. 

In April contractors learnt they 
would be paid £1,000 to 
acknowledge pricing difficulties 
experienced with processing. This 
payment was to cover both the 
increase in pricing errors and 
inconvenience caused by the 
automatic CIP processing system up 
until the end of March 2009. 

But Sue Sharpe, PSNC chief 
executive, told C+D there was "no 
doubt" pricing errors had continued 
in 2009-10 and that the committee 
would seek additional compensation 
for this. Janet Edginton, head of 
pharmacy audit at PSNC, added: 
"There is no doubt that CIP requires 
further improvement." 

NHS Prescription Services 
recognised the failings of the CIP 
system, Ms Edginton continued, 

Pharmacists have been urged to 
refer all men with lower urinary 
tract symptoms (LUTS) to their 
GPs for full reviews of their 
medication rather than continuing 
OTC care. 

Speaking at the launch of Nice 
guidance on the topic, consultant 
urological surgeon professor 
Christopher Chappie said 
assessment was "crucial" to rule 
out underlying causes such as 
prostate cancer. 

He added: "I hope that 

A Buckinghamshire hospital has 
been rocked by allegations of staff 
having sex in the pharmacy. 

The story made headlines in 
national newspapers after the claims 
were made by a whistleblower 
involved in an employment dispute. 

In documents set to go before a 
judge later this year, former nursing 

v— ■--:~ r : ..v..;" .v: , - ,.,,. ., ^ . . .. .. . i . .; ,.! ,.—- 

C+D has previously reported on the 
impact of CIP pricing errors on 
pharmacy businesses 

"and that's why they have agreed to 
make error payments". The pricing 
division was also working with PSNC 
to help achieve accuracy, she said. 

But the error payment deal and 
the inaccurate payments came 
under fire from contractors. C+D 
Senator and Lloydspharmacy 
regional manager Graeme Betts said: 

community pharmacists support 
this guideline from Nice by advising 
men who wish to purchase OTC 
medicines for their urinary 
symptoms to visit their GP or nurse 
first so they can be thoroughly 

The comments followed national 
media criticism of pharmacists' role 
in selling P medicine Flomax to 
patients with benign prostatic 
hyperplasia (BPH). 

But Amish Patel, of Hodgson 
Pharmacy in Dartford, said the 

director Maggie Southcote-Want is 
reported to have accused bosses at 
Milton Keynes Hospital of a series of 
cover-ups, including an incident 
where two members of staff were 
caught having intercourse in the 
hospital's pharmacy. 

However, a spokesperson for the 
hospital denied any wrongdoing, 

"Who knows what the size of the 
recent rebate should be? It's a 
number which we all say 'well, OK, 
we're grateful to have it', but we've 
not got the clarity to tell whether it 
fulfils the whole size of what we 
should have." 

Graham Phillips of Hertfordshire- 
based Manor Pharmacy called the 
situation "nothing short of a 
scandal". He called for contractors 
to be paid correctly and openly. 

Ms Edginton agreed it was not 
acceptable for contractors to have 
the prescription forms they 
submitted priced inaccurately. "This 
is why PSNC is continuing to work 
hard to drive improvements in 
pricing accuracy," she added. 

Contractors still have until June 
30 to submit a written request for a 
check of a month's prescriptions to 
take place if they feel their payment 
up to March 2009 were significantly 

But John Evans, superintendent at 
Asda pharmacy, warned requesting 
such checks would be difficult for 
businesses with lots of pharmacies. 


guidance undervalued the role 
pharmacists could play. "I don't see 
why it should be an instant referral 
when we can deal with things, for 
example through a patient group 
direction," he said. CC 

Does the Nice guidance 
undermine your role as 
a pharmacist? 

stating that the incident had been 
investigated in full. 

"An allegation was made 
about inappropriate behaviour in 
the pharmacy. There was a full 
investigation which found there 
was no evidence to support 
the allegation," the spokesperson 
said. CC 

Sector 'crucial' in LUTS 

'Sex in pharmacy 1 scandal makes headlines 


i painkiller feared by headaches 

lurofen 200mg tablets (ibuprofen) provide faster and longer relief from 
headaches than standard paracetamol tablets'"' 

Vhy Nurofen. Be it a niggling, thumping or plain annoying 
|eadache, Nurofen can bring you fast and effective relief 
L going right to the source of pain. To find out more 
bout how Nurofen targets headaches visit 

Targeted relief from pain 

ssential Information for Nurofen 200 mg Tablets 

ame and Active: Nurofen 200 mg Tablets contain 200mg ibuprofen 

Ddications: For the symptomatic relief of mild to moderate pain, sin h as In \* 1.x Iic.UkI .1. he, 
eriod pain, dental pain, neuralgia, rheumatic and muscular pain, migraine, cold and flu 
'mptoms, sore throat and fever and pain of non-serious arthritic conditions, 
osage and Administration: Adults, the elderly and childien ovei 12 years' Take 1 or2caplets 
iken with water, up to three times a day as required. Do not exceed 6 caplets in any 24 hours. 
?ave at least 4 hours between doses. Not for use by children under 1 2 years of age. Do not 
se for more than 10 days, or if symptoms worsen, consult a doctor. 

ontraindications: Known hypersensitivity to ibuprofen or other ingredients. Histoiy of 
ronchospasm, asthma, rhinitis, or urticaria, associated with aspirin oi other non-steroidal anti- 
iflammatory drugs (NSAIDs). History of, or existing gastrointestinal ulceration/perforation or 
leeding, including that associated with NSAIDs, Severe hepatic failure, severe renal failure or 
!vere heart failure. Concomitant NSAIDs, including COX-2 inhibitors. Last trimester of pregnancy 
fecial warnings and precautions for use: SLE and mixed connective tissue disease 
astrointestinal disorders and chronic inflammatory intestinal disease. Hypertension and/or 
ardiac impairment. Renal impairment Hepatic dysfunction. Bronchial asthma or alleiqn disease 
il bleeding, ulceration or perforation, which can be fatal has been reported with all NSAIDs 
t anytime during treatment, with oi withi iui wai ning sym| itoms or a | irevii >us history ot Gl 

events. Caution with concomitant medications which could increase the risk of gastrotoxicity 
or bleeding, such as corticosteroids, or anticoagulants such as warfarin or anti-platelet agents 
such as aspirin. Withdraw treatment if Gl bleeding or ulceration occurs Possible reversible 
effects on fertility. Avoid use during the first 6 months of pregnancy if possible 

Side effects: Hypersensitivity reactions including, (a) non-specific allergic reactions and 
anaphylaxis, (b) respiratory tract reactivity e.g. asthma, aggravated asthma, bronchospasm, 
dyspnoea, (c) various skin reactions e g pruritus, urticaria, angiodema and more rarely exfoliative 
and bullous dermatoses (including epideimal necrolysis and erythema multiforme). 
Gastrointestinal disturbance including: peptic ulcer, perforation or Gl haemorrhage, headache, 
acute renal failure, liver disorders, haematopoietic disorders including anaemia. 
MRRP (Excl.VAT): £ 2.98 (24 tablets) £ 5 49 (48 tablets) £ 9.06 (96 tablets) 
Legal category: P 

Product Licence Number: PL 00327/0147 

Licence Holder: Crookes Healthcare Limited, Nottingham NG2 BAA 
Date of Revision: April 20 1 0. 

References: 1 Pearce L,etal. Practitioner 1983;227(1377):465-7. 2 Schachtel BP et al. 
Journal of Clinical Pharmacology 1996,36(12) :1 120-5 3 Data on file, Reckitt Benckiser. 

Ilways read the label. Nurofen 200mg tablets contain ibuprofen 


For more Q&As from the RPSGB AGM see 

Can we really solve the 
stress problem? 

"No, I don't 
think we can as 
the number of 
will always rise 
as well as 
services. The 
market is 
saturated in terms of community 
pharmacy - we don't want any more 
but we still complain about 
prescription volume." 
Anmish Patel, Hodgson Pharmacy, 
Longfield, Kent 

"I would not 
have thought so 
as there are 
always going to 
be the pressures 
associated with 
making sure 
you meet customers' needs." 
Kate Molyneux, Co-op Pharmacy, 

Web verdict 

Yes 21% 

I here's not muc h 
good news on the horizon according 
to our pessimistic respondents, with 
only one in five believing the sector's 
stress situation could be worked out. 
■■'■'sxt week s question: 
Will the new coalition government 
be good for pharmacy? Vote at 

National boards promise 
workplace pressure help 

RPSGB annual general meeting: time has come to tackle pressure 


Hannah If lyirmri 


All three RPSGB national boards 
have promised to tackle workplace 
pressures in community pharmacy. 

The comments came at the 
Society's annual general meeting 
and followed the C+D and PDA 
Union Salary Survey 2010's finding 
that less than 1 per cent of 
pharmacists felt the RPSGB's 
campaign on the issue had fully 
succeeded so far. 

Lindsey Gilpin, chair of the English 
board, told the AGM the time had 
come for pharmacists to stop 
putting up with workplace pressures. 

Ms Gilpin slammed the culture, 
which sees some people dispensing 
950 items a day, and said: "We want 
to give pharmacists the confidence 
to say, 'I am not happy with this'." 

Vice-chair of the Welsh board 
Mair Davies agreed workforce 
pressures were high on the agenda 
and said the board's key priorities 

ACM speakers: workplace pressures a key joint priority 

were to set minimum standards for 
safe practice and to reduce time- 
wasting red tape. 

Ms Davies added: "[Work on] 
workplace pressures will be co- 
ordinated across the three boards so 
the sum of the whole becomes 
greater than the parts." 

Scottish board chair Sandra 

Society seeks help on pensions 

The Department of Health (DH) has 
been approached for funding to help 
offset the RPSGB's pension deficit, 
the Society has confirmed. 

The full size of the pension deficit 
will be made available next year, but 
the Society's £1.9 million surplus in 
the last financial year dropped to 
just £39,000 after adjusting for 

Director of finance Graham 
Duncan confirmed the Society had 

approached the DH on the matter. 

He added: "I, the chief executive 
and the treasurer, together with the 
trustees, will continue to provide 
additional funding to the pension 
fund as part of the demerger." 

Mr Duncan said the Society was 
confident that its business plan for 
the next three years provided a 
financially viable organisation, but 
admitted conditions for subsidiary 
businesses remained difficult HF 

Melville added that the future 
professional body would champion 
pharmacists on their behalf. 

"We need a professional body to 
keep in touch with live everyday 
issues and to address them," she 
said, highlighting issues including 
supply shortages and workplace 

Questions asked 
at the AGM 

Q How many staff members do 
the boards have and what do the 
boards cost? 

A There are 15 employees 
supporting the boards and the 
total cost of supporting the 
boards in 2009 was £2.7 million. 

More questions online at 

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In our fast moving profession, it is crucial to keep abreast of new developments. 
Membership of the new Society will enable you to do just that. 

We'll support you to provide the best for your patients, and in meeting the CPD requirements of 
the new regulator. And we'll also be there to help you develop further if you wish to specialise in a 
new area or take on new services. 

We're working collaboratively with the profession to put in place the support frameworks and 
assessments which mean your development will be recognised, allowing you to achieve 
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We're right behind you - helping you to develop, helping the profession to develop. 
Find out more at 

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The APPG: what next for 
pharmacy in Parliament? 

The all-party pharmacy group lost key members in the election, but 
vice-chair Baroness Cumberlege tells Zoe Smeaton all is far from lost 

The all-party pharmacy group 
(APPG) has long been a key and 
influential player in pharmacy 
lobbying, helping to secure major 
victories for the sector such as the 
publication of the pharmacy white 
paper, which the group had 
pressured the government to deliver. 

Baroness Cumberlege says the 
group has also been instrumental in 
shaping NHS policy within which 
pharmacists operate. And she adds: 
"Perhaps most importantly, we have 
achieved a huge amount of 
consensus among the main political 
parties in Parliament on key issues 
relating to health policy and the part 
that the pharmacy profession should 
play in the NHS. There are few other 
policy areas, in health or elsewhere, 
where such a degree of consensus 
exists - even in these times of 
coalition and collaboration." 

The job now must be to maintain 
this pace, the vice-chair says, to 
ensure pharmacy's voice continues 
to he heard in the new political 
landscape. To make this happen 
newly elected and re-elected MPs 
must join the APPG and a new 
leadership team must be assembled. 

Baroness Cumberlege says 

Baronness Cumberlege: Pharmacists 
should contact their MPs and urge 
them to join the APPG 

progress is being made on these, but 
admits that finding someone with 
the commitment, expertise and 
energy of former chair Dr Howard 
Stoate will not be an easy task. 

However, she has some words of 
reassurance: "I am in contact with a 

number of my parliamentary 
colleagues and I am confident we 
will build another strong team 
during the summer. It will inevitably 
take some time, but we are on top of 
the task." 

In a message to C+D readers, the 
vice-chair asks that pharmacists help 
her by contacting their local MPs. 
Being enthusiastic about pharmacy 
and asking them to join the group 
could make all the difference. "The 
general election has ushered in 
hundreds of new MPs. Some have an 
understanding and interest in 
pharmacy, some are less familiar 
with the profession and its services," 
she says. "But it is vitally important 
that as many MPs as possible hear 
not just from me and the group's 
secretariat about joining the APPG 
They also need to hear from 
pharmacists in their constituencies. 
If you contact them and ask them to 
join the group, they are more likely 
to do so. A request from a constituent 
can have a telling effect. All you need 
to do is send them a short email." 

Doing so could just help the group 
continue to facilitate debate and 
discussion with policymakers and 
politicians, and ultimately to press 

Lobbying tactics 

"The APPG has had a very 
positive influence on behalf of 
pharmacy and the new chair will 
have a hard act to follow in 
Howard Stoate. But we need 
local lobbying too so it's really 
important for pharmacists to 
talk to their MPs to ensure they 
have a good understanding of 
what pharmacy has to offer and 
how it can help to balance 
budgets in these difficult 
economic times." 
Alastair Buxton, PSNC head of 
NHS services 

"We have a fantastic opportunity 
with the pharmacy white paper 
and a lot of that was due to the 
APPG. I think it's absolutely 
crucial that pharmacists now get 
involved and talk to new MPs, 
and I don't mean whingeing- 
we need to make a good 
impression on them." 
Graham Phillips, Hertfordshire- 
based Manor Pharmacy 

for improvements such as better 
rewards for quality and outcomes in 
pharmacy, a greater focus on 
tackling adherence and waste, and 
stronger local commissioning. 

For more advice on how to 
contact your MP you can contact 
the group's secretariat (via or contact C+D 
( to help 
arrange for your MP to visit your 
pharmacy. To find your local MP 
enter your postcode at 

What key priorities do you want to see the APPG lobby on? 

Number the boxes in the order that you would like to see the APPG lobby on and return the form to us: 

Decriminalising dispensing errors Ql Improving medicines waste and adherence 

J .iock shortages _J Securing sustainable funding for quality outcomes 

□ Raising public awareness ©f pharmacy services L_) Other (please state) 

Your name: 

Job title: 

Pharmacy name and address: 


Email address: 

Daytime phone number: 

Post this completed page to: C+D, 8th Floor, Ludgate House, 245 Blackf riars Road, London SE1 9U Y, fax it to 020 9721 8132 or 

email your views to 

UBM Medica would like to keep you up to date about our products and services for healthcare You can view our privacy policy at 
professionals. Our emails may also include information from other carefully selected 

companies including promotional materials from pharmaceutical companies that may be of Q Please tick this box if you are happy for UBM Medica to share your details with carefully 

interest to you. Your details WILL NOT be passed on to third parties without your consent. If selected third companies that wish to provide you with information about products and 

you do not wish to receive information from UBM Medica, please tick this box Q services for healthcare professionals. 

Chemist Druggist 29.05.10 

Try out C+D's clinical quiz at: 


Clinical debate C+D's Chris Chapman looks at the evidence behind the headlines 

MMR: the stampede that cost us the herd 

If you ever doubt how much 
impact a single research paper can 
have, think about Andrew 
Wakefield's 1998 paper in the 
Lancet linking MMR and autism. 
The disgraced doctor was found 
guilty by the CMC of serious 
professional misconduct last week 
over the MMR-autism issue. The 
devastating repercussions of the 
infamous (and now retracted) paper 
are still being felt by pharmacists. 
Dr Wakefield's paper looked at 

12 children with developmental 
disorders who had been referred to a 
gastroenterology unit. In eight of the 
children, onset of behavioural 
symptoms was associated, by the 
parents, with the MMR vaccine. At 
a press conference Dr Wakefield 
urged the use of single vaccines at 
yearly intervals. 

The press picked up on the story 
and worried parents heard about it. 
Dr Wakefield's calls started a 
stampede and immunisation levels 
began to drop. 

In the decade that followed, 
researchers launched a thousand 
rebuttals. The evidence base is now 
overwhelming in its verdict. Perhaps 
most importantly, a Cochrane review 
of 139 articles to assess the jab in 
children found "no credible 
evidence" of a link between the jab 
and either autism or Crohn's disease. 

But the damage had already been 
done, as the authors concluded: "The 
lack of confidence in MMR has caused 

great damage to public health." 

This is confirmed by the stats. 
Measles is highly infectious, and 
requires immunisation levels of 
around 90 per cent for herd immunity 
to be achieved. If vaccination hits 95 
per cent, measles, mumps and 
rubella are wiped out. This has been 
accomplished in Finland. 

But in England the MMR 
immunisation rate for children 
reaching their second birthday 
stands at around 85 per cent. While 
this has recovered from its lowest 
ebb - around 80 per cent in 2003-04 
- it pales in comparison to the more 
than 91 per cent of children receiving 
the jab before the Wakefield paper. 

The result is pharmacists are once 
again faced with diseases that had 
been going the way of the dodo. In 
1998 there were 56 cases of measles 
in England and Wales - by 2009 there 
were 1,144. It's similar for mumps - 
121 cases in 1998, 7,628 in 2009. 

The evidence speaks for itself. The 

MMR-autism link is unfounded. 
The UK has lost herd immunity to 
diseases the public were once 
shielded from. If we are to stop the 
resurgence of these potentially fatal 
conditions, we need to follow the 
lead of our Scandinavian colleagues 
and encourage parents who ask to 
ensure their child is protected. 

As the profession rapidly moves 
towards being a key player in 
vaccinations - with community 
pharmacies vaccinating people 
against everything from hepatitis 
to seasonal flu - the importance of 
pharmacists' effort cannot be 

To discuss this subject in private 
with your pharmacy colleagues, 
join the debate in C+D's Linkedln 
group at - 
search for Chemist and Druggist. 

Chat with Chris on Twitter: 


The sums are simple 
The more you spend the more 
you save And the discounts 
start from the very first pound. 
That's how to buy generics 


Regenovex set for 
£1 million campaign 

Jointcare range Regenovex will be 
the focus of a television advertising 
campaign later this year. 

The range, launched by Deep Heat 
manufacturer Mentholatum at the 
beginning of this month, will be 
supported by a £1 million package 
that also includes trade and 
consumer PR, advertising, sampling 
and training. 

Regenovex is the subject of 
ongoing scientific research at a UK 
university, to be presented at 
healthcare conferences this year, and 
further research is planned for later 
in 2010, including a trial in the US. 

The range includes one-a-day 


»t focus 

• An estimated nine to 1 1 
million people in the UK live 
with arthritis (www.arthritis 

• The jointcare market is 
worth £83.3 million 
(IRI, October 2008). 

capsules "for daily joint health" 
and two topical products - a gel 
and a 12-hour patch - "to target 
problem joints". 

£22.47/30 capsules; 
£10.21/40ml gel; 

347-2669, 347-2677 
Laser Healthcare 
01202 780558 

if brxAi 


; I 

Zantac 75 web game is viral 

Ceuta Healthcare has 
launched a 'viral' web game 
forCSK Consumer 
Healthcare's heartburn 
and indigestion remedy 
Zantac 75. 

The game can be accessed 
at from 
the end of May, part of a 
£1 million multimedia 
campaign for the brand. 
Potential players will be 
targeted via an email 
campaign, press advertising and PR 

Using the brand's "defuse your 
food" strapline, players will be able 
to look at the effect of different 
foods on digestion, and pharmacy 
assistants will have access to an 
educational variation of the game. 

Zantac advertising will appear in 
women's nationals and urban 




commuter magazines until the end 
of June, and new PoS material is 

Price: £7.49/24 tablets 

Ceuta Healthcare 
Tel: 01202 780558 

Magicool on TV for summer 

Magicool and Magicool Plus will be 
supported by a television campaign 
from the beginning of June. 
The frequency of TV spots will be 

06-00143A5cl I "Ii Pfizer Limited 2009 All riqhts reserved I Date of preparation: Julv 2009 


1 1 


9 S| i 

increased during hot spells, says 
brand owner FranceMed Pharma, 
and the campaign will run until 

Magicool products are patented 
self-chilled sprays, and the Plus 
sub-range is available as Magicool 
Plus Prickly Heat and Magicool Plus 
Itchy Skin. 

The range is free from steroids anc 
antihistamines, the company says. 

Prices: from £3.99 

Pip codes: See C+D Monthly Price 

List or 

FranceMed Pharma 

Tel: 0208 645 0773 

Sanatogen High Protein 
Powder from Power Health 

Power Health 
Products has 
acquired the 
distribution rights 
for Sanatogen 
High Protein 
Powder from 
Bayer Consumer 

The product 
was briefly unavailable in the UK but 
following the change of rights it is 
now available to order again. 

The product is a high protein 
power that can be added to food. 

Bayer Consumer Care took over 
the Sanatogen range when it 

acquired Roche Consumer 
Health in early 2005, and will 
continue to hold the trademark 
for Sanatogen High Protein 

Prices: £7.65/275g 
Pip code: 315-5363 
Tel: 01759 302595 

Check out what's on TV 
this week 


Need to train a dispensary assistant? Benchmark is your solution 


Rat iopharm launches nail fungus treatment 

Ratiopharm UK has launched an 
OTC treatment for fungal nail 
infection. ClearFeet AF Nail Fungus 
Treatment is a "unique bio-active 
fungal blocker" in a brush-on 
applicator, according to the company. 

It will be supported by "an 
extensive PR campaign" focusing on 
women's magazines, Ratiopharm 
says, and a website will educate 
consumers about the condition 

The treatment is available in 

three-pack shelf-ready units, and 
shelf edges and consumer leaflets 
will be available for display in 
pharmacy stockists from next month 
ClearFeet was developed by Serrix 
Consumer Health. 

Price: £14.95/4ml 
Pip code: 354-4632 
Ratiopharm UK 
Tel: 02392 386199 

Market focus 

• Fungal nail infection (FNI) is the most 
prevalent foot problem. 

• Up to three million people in the UK have FNI. 

• FNI is most common in people aged 18-65. 

• More men than women suffer from FNI. 

Source: Mycoses, British Journal of Dermatology 

atiopharm head of OTC Rob Hall explains ClearFeet's retail opportunities 

How big is the fungal nail 
infection (FNI) market? 

Fungal toenail infection is a common 
problem; some three million people 
are affected in the UK and this figure 
is probably much higher as most 
sufferers fail to treat. Pharmacies 
need to encourage more people to 
treat and there is huge category 
potential here. The UK OTC fungal 
nail infection market is currently 
worth £5.65 million a year (IRI); 
however, the athlete's foot market 

is worth £20. 3m (IRI), even 
though FNI is more common than 
athlete's foot. And only 600,000 
prescriptions for FNI treatment are 
dispensed per annum (INS), so the 
potential for effective OTC products 
is massive. 

Is the fungal nail infection 
market growing? 

The ageing population is seeing an 
increase in FNI and its links to 
diabetes and poor circulation. 

ClearFeet AF Nail Fungus Treatment 
is suitable for diabetes sufferers. 

Why should pharmacies 
stock ClearFeet? 

ClearFeet AF Nail Fungus Treatment 
will give pharmacists 30 per cent 
profit on return. 

What opportunities are 
there for link sales? 

from athlete's foot are estimated to 
have FNI. 

How do you plan to develop 
the footcare market? 

Up to 30 per cent of people suffering 

We are keen to develop the footcare 
category, creating innovative 
product solutions that offer sufferers 
real, proven treatment benefits and 
pharmacists great business 
opportunities. The launch of a 
ClearFeet athlete's foot treatment is 
planned for next year. 

To find out more call 0800 731 0370 
or email accumulatorQ/actavis co uk 


You're busy, with better things 
to do than spend all day shopping 
around for deals and organising 
training. You've got a business to run, 
so why not leave the legwork to us ? 
That's how to buy generics 

How to buy generics 


What do you think? 

A time of change? Here's my wish list 


It was a quiet day in the pharmacy so I opened my 
paper, only to read the front page headline: 
"Deputy PM Nick Clegg says: Tell us the laws you 
want scrapped!" It was all I could do not to phone 
Parliament and shout, "Oh, oh, please - can I go 
first!", because number one has got to be 
decriminalising dispensing errors, followed closely 
by the responsible pharmacist legislation. 

Then really, the Medicines Act as a whole could 
do with reform. Run out of your tablets? Sign this 
simple form so that I can give you a week's supply 
and charge it to the NHS. Methadone script 
doesn't account for weekends or bank holidays? 
Allow me as a registered healthcare professional 
to alter it as necessary, and for this to be counter- 
signed by a pharmacy technician, so that we can 
supply what is needed - on CDs or any script for 
that matter. 

Why did no one think of this before? Think of all 
those administrative procedures and forms that 
could be resolved at a stroke, such as the 
ludicrously cramped discharge letters sent from 
our local hospital. These were designed by 
committee, so every department's information is 
crammed onto one side of A4. This means that a 
third is a big blank space for the briefly scrawled 
diagnosis - usually something really astute and 
specialised such as "Off legs" - while the truly 
important bit about the discharge drugs is 
squeezed into the bottom three inches. 

And why stop there? If this really is going to be 

an open government, for the people, then I know 
all pharmacists would love to be 'king for a day', 
because there's so much wrong with the NHS 
world. If I were in charge, no surgery would have 
an automated telephone answer system, a sort 
of electronic doctor's receptionist that is even 
more effective at preventing contact with 
patients, and at delaying busy healthcare 
colleagues with urgent queries. Manufacturers' 
quotas would be banned, any patient with more 
than three items would automatically have to call 
back the next day, and anyone drumming their 
fingers on the counter or leaning halfway into the 
dispensary can be slapped. 

So that is sort of why I am almost excited abou 
the old RPSCB being scrapped. The CPhC 
consulting on new standards, a new professional 
body, devolved powers, a new 'branch network' of 
local practice forums, an ever-strengthening band 
of clinical pharmacists at PCT determining 
contracts through pharmaceutical need instead of 
commercial need, and prescribing pharmacists 
within GP surgeries. For those of us who 
remember PIANA - this is that new age! 

Maybe it's coalition euphoria, and just as the 
new government won't end wars and poverty, I do 
realise there are more challenges for pharmacy to 
tackle. But I have to say that I have feared for my 
profession a lot more in the past than I do now, 
and "Tell us what to change" isn't a bad slogan for 
the new PLB either. 

In search of the entrepreneurial spirit 

I have spent a remarkable few weeks 
filming The Victorian Pharmacy for 
BBC2. It has been great fun and I 
hope the series and accompanying 
book will help community pharmacy 
get the recognition it deserves. 

The four one-hour programmes 
(to be aired on BBC2, hopefully this 
autumn) follow the development of 
pharmacy from the early Victorian 
period, in the 1840s (when I make 
up Oil of Earthworm, for example), 
through to the late 1800s (when I 
make gunpowder and fireworks). The 
other two presenters are Ruth 
Goodman and Tom Quick, historians 
from whom I learned a great deal. 

What came over to me most 
strongly was the entrepreneurial 
spirit of the Victorian pharmacists. 
Many of them had to fight to make a 
living (the pages of the C+D used to 
list those who had gone bankrupt) so 
they were certainly inventive. 

A modern pharmacy is an 
illustrated history of our forebears' 
willingness to tackle anything to 

provide the public with what it 
wants. People sometimes ask why 
pharmacies stock anything other 
than medicines, and the answer is 
because we were the experts in the 
high street in chemicals, plant 
extracts and health. 

Why perfumes? Because we had 
expertise in essential oils and used 
to blend our own perfumes. Why 
shaving equipment? Because we not 
only made shaving preparations but 
also shaved customers. Why reading 
glasses and dental care? We used to 
make tooth powders, extract teeth, 
test eyes and fit glasses. Indeed, the 
Pharmaceutical Society was formed 
decades before the equivalent 
dentistry and optics bodies. The list 
goes on: photography, sexual health, 
dermatologicals, etc. Whatever the 
public wanted, we bought, made or 
created a service for it. 

We need that Victorian 
entrepreneurial spirit now. 
Community pharmacy faces the 
worst financial depression for over 

half a century. It is tethered to 
dispensing, for which it will inevitably 
get less money; the commissioning 
of clinical services by the PCTs is, to 
put it mildly, variable in its quality, 
insight and effectiveness. We need 
to reconnect to our customer base, 
to talk to them and offer the services 
- NHS funded or private - they want. 

And we need not be afraid of 
charging for them. For example, 
those of us in middle age who live 
far from our parents would be willing 
to pay a lot of money for the peace 
of mind that could come from a 
pharmacist engaging with our 
parents and helping manage their 
medicines (including, occasionally, 
helping challenge their GP). 

We will see some innovative 
practices celebrated in next month's 
C+D Awards. We need more. Engage. 
Innovate. Now. 

Professor Nick Barber, Centre for 
Medication Safety and Service 
Quality, The School of Pharmacy, 
University of London 


14 Chemist ---Druppist 29.05.10 

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17 MUR cases ► 19 Prescribing ► 20 Euro Rxs ► 22 Work safety ► 26 Design awards ► 29 

Away days 

MUR case studies 

A woman with diabetes has tingling hands and feet, while a heart 
failure patient reports an upset stomach. What do you advise? 

ChinjalJ Patel MRPharmS PC Dip 

Two case examples highlight issues to consider 
when carrying out medicines use reviews. 

Diabetic neuropathy, hypertension and 

People with type 2 diabetes are at a high 
cardiovascular risk, which can be reduced by an 
appropriate reduction in blood pressure and 
cholesterol, together with dietary changes. Some 
antihypertensive drugs can interfere with blood 
glucose and lipid levels, while the side effects of 
hypoglycaemics may result in patient non- 
compliance, leading to diabetic neuropathies 
caused by hyperglycaemia. 

Diabetic neuropathies are nerve disorders 
caused by both type 1 and type 2 diabetes. They 
occur because of decreased blood flow and 
hyperglycaemia, and are more likely if blood 
glucose levels are poorly controlled. The types of 
neuropathy can be grouped as peripheral (most 
common), autonomic, proximal or focal. 1 
Peripheral neuropathy causes pain or loss of 
feeling in the hands, arms, feet and legs. 

Autonomic neuropathy commonly affects the 
gastrointestinal and genito-urinary systems. It can 
also affect the heart, lungs and eyes as well as 
cause changes in perspiration. More importantly, it 
can mask the warning signs of low blood sugar 
leading to hypoglycaemia. 

Proximal neuropathy is associated with the 
motor neurone system, causing pain and weakness 
in the thighs, hips and legs. Focal neuropathy (also 
called mononeuropathy) damages specific nerves. 
It can cause more severe pain and often has a 
sudden onset but usually only short duration. 
Common treatments for diabetic neuropathies 
include antidepressants and anticonvulsants. 2 

Supported by jp^j 


Mrs Collins is a 51 -year-old hypertensive with 
type 2 diabetes and high cholesterol. She asks 
about your free medicines use review service as 
she is worried she will end up on insulin. She 
comes in later with a bag of medicines, most of 
which match up with the medicines on her PMR. 
However, there are other medicines she has bought 
OTC and some she has obtained from her family. 
Current medication from PMR 

Metformin 500mg ltds 

(titrated up over last two years) 

Cliclazide 80mg2bd 

(titrated up over past six months) 

Ramipril 5mg caps 1od 

(increased from 2.5mg 1od two months ago) 

Bendroflumethiazide 2.5mg 1om 

(started six months ago) 

Simvastatin 40mg 1od (started six months ago) 

Aspirin 75mg disp tabs 1od 

(started six months ago) 

Amitriptyline 10mgtabs 1on 

(started six months ago) 

Duloxetine 60mg tabs 1od 

(started two months ago) 
s Lactulose solution 15ml bd 

(started six months ago) 
OTC medicines 


Evening primrose oil 

Indigestion tablets containing calcium carbonate 
Calcium and vitamin D 

Obtained from family 
Cold and flu caplets. 

When Mrs Collins was started on metformin, 
she reverted back to her old eating habits, thinking 
the tablets would do the trick now. Her blood 
glucose levels became progressively higher so the 
CP introduced gliclazide. However, she has noticed 
weight gain and tingling pain in her hands and feet, 
with aching legs. 

Believing the weight gain and neuropathic 
symptoms to be caused by gliclazide, she recently 
decided to take only one tablet daily Her CP 
prescribed some anti-depressants for the pain but 
she doesn't like taking them. 

lnixicu poinxs co ci 

Non-compliance with gliclazide can put her at 
high risk of diabetic complications - are her 
symptoms due to diabetic neuropathy? 

The cold and flu product contains a 
decongestant and is not suitable in high blood 
pressure or diabetes. 

Are the aching legs a sign of diabetic neuropathy? 
Or is it myalgia from simvastatin or ramipril 7 

Looking <ai the inedication 

Type 2 diabetes (metformin, gliclazide) 
Did the gliclazide cause the weight gain 7 
Why hasn't the metformin dose been 

titrated up? 

Diabetic neuropathy (amitriptyline, duloxetine) 
How compliant is the patient? 
Duloxetine has been prescribed for two months, 

29.05.10 Chemist -Druggist 







r 18 MUR cases ► 19 Prescribing ► 20 Euro Rxs ► 22 Work safety ► 26 Design awards ► 29 Away days 

and it seems Mrs Collins still has the neuropathic 
symptoms. The BNF 59 3 says discontinue 
duloxetine in diabetic neuropathy if there is no 
response after two months. 
Hypertension (ramipril, bendroflumethiazide) 

Bendroflumethiazide can aggravate diabetes by 
causing hyperglycaemia and may alter plasma lipid 
concentrations. 4 

Did the ramipril cause aching legs? 

' Did the simvastatin cause aching legs? 

Is the aspirin causing gastric problems? Could 
this explain the use of indigestion tablets? 
Constipation (lactulose) 
© Lactulose can sometimes affect diabetes control. 
@ What caused the constipation - amitriptyline, 
calcium or indigestion tablets? 
OTC medicines as above 

The calcium and indigestion tablets can cause 

Hypertension, iron-deficiency anaemia 
and heart failure 

Hypertension is a major risk factor for developing 
heart failure, which is commonly characterised by 
fluid retention, breathlessness and fatigue. Non- 
cardiac conditions, such as severe iron-deficiency 
anaemia, can also predispose to heart failure. 5 The 
main types are left ventricular systolic 
dysfunction (where the left ventricle doesn't 
pump as efficiently as it should during each 
heartbeat), diastolic dysfunction (where the left 
ventricle doesn't efficiently fill up with blood 
between each heartbeat when the heart is 
resting) or a combination of the two. 

Mr Taylor is a 61 -year-old regular customer. He is 
a vegetarian and doesn't have an iron-rich diet so 
takes prescribed ferrous sulphate. 

Six months ago Mr Taylor, who is also on anti- 
hypertensive medication, had a fall and while in 
hospital was given ibuprofen for back pain, which 
he continued to take after discharge without his 
GP's knowledge. Further tests in hospital 
diagnosed heart failure. 

Today Mr Taylor asks for the best remedy for a 
cold he has had for about a week; he has also lost 
his appetite. He has just returned from a holiday 
abroad suffering from nausea and diarrhoea, which 
he believes is due to a stomach virus. You notice 
from his PMR that he is on multiple medicines 
including digoxin and say he is an ideal candidate 
for an MUR, to which he agrees. 
Current medication from PMR 
® Losartan 50mgtabs lod 

Furosemide 40mgtabs 1od 

Digoxin 125mcgtabs 1od 

Bisoprolol 5 mgtabs lod 
® Simvastatin 40mg tabs 1od 
© Ferrous sulphate tabs 200mg ltds 
Other medication 

s Ibuprofen 200mg tabs 1- 2tds pm (prescribed 
from a previous hospital admission, and then 
bought from GSL section). 
® Cod liver oil for joints. 

Initial points to consider 

® Is the nausea, diarrhoea and loss of appetite due 

Because of side effects with gliclazide, Mrs 
Collins hasn't complied with the dose. You 
reassure her that gliclazide can sometimes cause 
weight gain but, if she is not fully compliant, the 
resulting hyperglycaemia can lead to further 
diabetic complications and aggravate her 
neuropathy. Amitriptyline makes her tired the 
next day. She has not been fully compliant with 
the duloxetine. However, she complies with all 
the other prescribed medication but does not 
need the lactulose. You say she should discuss 
further treatment options with her CP. You say 
that the cold and flu caplets are not suitable and 
she should check with a pharmacist or GP before 
taking non-prescribed medication. 
Would you suggest any medication changes? 

Gliclazide: GP to review. Metformin: GP to 
review dose. Lactulose: not required anymore. 

to digoxin? Did a virus cause the loss of appetite? 
Could the symptoms be due to a poor diet abroad? 

The diarrhoea can cause hypokalaemia, which 
can further lead to digoxin toxicity. 
© Is the GP aware the patient is taking ibuprofen? 
NSAIDs can impair renal function, raise blood 
pressure and cause salt and water retention, 
making heart failure worse. 
Looking at Mr Taylor's medication 
Iron-deficiency anaemia (ferrous sulphate) 
s Is he fully compliant with the ferrous sulphate? 
(Inadequate iron levels can aggravate heart failure). 
Heart failure and hypertension (losartan, 
digoxin, bisoprolol, furosemide) 
® Is the patient fully compliant? 
® Losartan can cause diarrhoea, taste disturbance, 
fatigue and anaemia. 

Ferrous sulphate gave Mr Taylor diarrhoea on 
holiday, so he substituted it with iron-rich 
foods. You explain that iron is essential for the 
heart and that dietary intake alone would not 
replenish his deficiency. You ask him if his GP 
knows he is taking ibuprofen, as it can affect 
digoxin levels. He hadn't told him. The 
combination could raise his digoxin level, which 
may be linked to his nausea and diarrhoea, 
possibly exacerbated 

by his iron-deficient state. In addition, ibuprofen 
can cause internal bleeding, worsening anaemia. 
You mention you will make your 
recommendations on the MUR form to his GP 
and suggest steam inhalations for his cold, with 
advice to see his GP if there is no improvement. 
Would you suggest any medication changes? 
Digoxin: GP to review - could be signs of 

Discussion with GP 
You contact Mrs Collins' GP about the 
hyperglycaemia, most likely resulting from 
non-compliance with gliclazide. She also has 
signs of neuropathic pain, which could be due 
to hyperglycaemia and non-compliance with 
the antidepressant. The GP agrees and asks 
you to refer her to him. You post him a copy 
of the MUR. 

Counselling points for the patient 

Advise regular blood glucose, BP and 
cholesterol checks. 

Take metformin with or after food. 

Avoid grapefruit juice, as it interacts with 

Advise on healthy diet - low in fat and salt. 

Provide patient information leaflets on 
diabetes, high blood pressure and cholesterol. 

..... ......... 

Hypokalaemia from furosemide may be further 
aggravated by recent diarrhoea. 

Is any hypokalaemia causing digoxin toxicity? 
a Furosemide can cause nausea and Gl problems. 

Hypercholesterolemia (simvastatin) 

® Can cause anaemia and gastrointestinal effects 

including abdominal pain, diarrhoea and nausea. 

References are available online at 

Chinjal J Patel is a community pharmacist in 
y, Leicester. 

Download a CPD log sheet that helps you 
complete your CPD entry when you 
successfully complete the 5 Minute Test for 
this Update article online (See p19). 

digoxin toxicity. Ibuprofen: GP to review. 

You contact the G P about the ibuprofen 
interacting with the digoxin, which may be 
linked to the nausea and diarrhoea. The GP has 
no record of this. He asks you to refer him for a 
review. You send a copy of the MUR. 

Advise an annual flu vaccination. 

Advise vaccination against pneumococcal 
disease (only required once). 

Reduce salt, avoid excess fluid intake, avoid 
alcohol and advise on regular exercise. 

Check patient can recognise signs of cardiac 
failure worsening: breathlessness, ankle swelling, 
fatigue and sudden weight gain. 

Monitor renal function, urea, creatinine and 




The first of two articles on 
blood tests looks at interpreting 
the results 

Get C+D's CPD Zone content sent to your inbox every week for free 

Sign up for the CPD Bulletin at 

What is autonomic neuropathy? Why might patients 
taking gliclazide be non-compliant? What are the side 
effects of losartan? Why should ibuprofen be avoided in 
heart failure? 

Using two case studies as examples, this article discusses 
problems that may occur with drugs used in type 2 
diabetes, high cholesterol, hypertension, anaemia and 
heart failure. 

Read the MUR tips for type 2 diabetes and heart 
failure on the C+D website at 

» Find out more about diabetic neuropathy from the 
Patient UK website at 

Revise your knowledge of the drugs used in treating 
type 2 diabetes and diabetic neuropathy by reading 
sections 6.1.2 and 6.1.5 in the BNF. 

Revise your knowledge of heart failure treatment by 
reading the Update on chronic heart failure, C+D April 17, 
2010, p17-18, or online at 

Update your knowledge of iron-deficiency 
anaemia from the Patient UK website at 

Are you now familiar with the drugs used to treat type 2 
diabetes, high cholesterol, hypertension, anaemia and 
heart failure, and the problems they may cause? Could 
you confidently carry out an MUR involving these 

Registering for Update 2010 costs £37.60 (inc VAT) and can be done easily 
at or by calling 0207 921 8425. 

Signing up also ensures that C+D's weekly Update article is delivered 
directly to your inbox free every week with C+D's email newsletter. 

Get a CPD log sheet for your portfolio when you successfully complete 
the 5 Minute Test online. 

Which antihypertensive? 

David Spencer, pharmacist at the 
Update Pharmacy, carries out a 
quarterly analysis of a local GP 
practice's prescribing data as part of 
a prescribing advice service. 

David raises the issue of 
angiotensin-renin system drugs 
(ARSDs) with senior partner Dr 
Mo Merali. 

David says: "I've noticed that the 
cost of ARBs (angiotensin II receptor 

antagonists or blockers) in this 
practice is quite high and it's rising 
steadily. It's rather above the Nice 

David explains the relative rate of 
prescribing of ACE (angiotensin 
converting enzyme) inhibitors and 
ARBs in the practice and the relative 
costs of the drugs. 

Mo replies: "Wow, I didn't realise 
they were making such a hole in our 

"Do you know why ARBs are being 
prescribed?" David asks. 

"I would imagine they are mainly 
being substituted for ACE inhibitors 
for patients troubled with cough side 
effects. Also, I sometimes prescribe 
an ARB as an add-on if a patient's BP 
is not being adequately controlled on 
an ACE inhibitor alone." 

"As far as both those reasons are 
concerned, I think the evidence 
shows that prescribing ARBs is 
generally not necessary or justified," 
David replies and goes on to 
demonstrate his points. 

"Well, we don't have a specific 
prescribing policy for this important 
group of drugs at the moment," says 
Mo. "Perhaps it's time you drew one 
up for us." 


1. What are the relative rates of 
prescribing and costs of ARSDs? 
2 What are the Nice 
recommendations on relative 

3. How necessary or justified is 
the substitution of ARBs for 
cough caused by ACE inhibitors? 

4. How justified is prescribing of 
ARBs alone or in combination 
with ACE inhibitors for 
hypertension and other conditions? 

1. In primary care in England, about 
70 per cent of ARSD prescribing is for 
ACE inhibitors, with 30 per cent for 
ARBs. But ARBs account for 70 per 
cent of the total spend on ARSDs. 

2. 80 per cent ACE inhibitors/20 per 
cent ARBs. This would represent a 
saving of around 23 per cent on the 
£300 million annual cost of ARSDs 
in England alone. Only about 12 per 
cent of GP practices achieve this. 

3. The major benefit of ARBs over 
ACE inhibitors is their lower rate of 
cough. However, cough may not be 
as common with ACE inhibitors as is 
perceived: the percentage of people 

reporting cough in randomised 
controlled trials is about 10 per cent, 
and as low as 2 per cent in 
observational, real world studies. 
Discontinuation rates due to cough 
are lower: only 4.2 per cent of 
patients taking an ACE inhibitor 
stopped treatment because of cough 
compared with 1.1 per cent taking an 
ARB. 1 Cough sometimes results from 
other, overlooked, causes, eg 
pulmonary oedema. 
4. For hypertension and all other 
indications, ACE inhibitors are the 
first-line choice. 2 An ARB alone is 
only indicated if an ACE inhibitor is 
discontinued because of intolerable 
cough. There is generally no benefit 
in prescribing an ACE inhibitor plus 
an ARB, and outcomes are often 
worse than with an ACE inhibitor 
alone. 3 

References are available online at 



1 17 MUR cases 4 19 Prescribing 20 Euro Rxs 22 Work safety 26 Design awards ; 29 Away days 


This series aims to help you make the right decisions when confronted by an ethical dilemma. Every month we present a scenario likely to arise in a 
community pharmacy and ask a practising pharmacist and/or a member of the Pharmacy Law and Ethics Association (PLEA) to comment on the legal and 
ethical implications of the actions open to you. Readers are invited to have their say at 

prescription from Europe 

he arrangements to dispense overseas 
prescriptions apply only to European 
Economic Area (EEA) and Swiss- 
registered doctors and dentists and do not extend 
to any Controlled Drugs, including Schedule 5 
CDs, nor medicines that do not have a marketing 
authorisation in the UK. A pharmacist is not 
compelled to dispense EEA and Swiss 
prescriptions and if he or she does dispense it the 
prescription will need to be treated as a private 
one and incur normal private dispensing charges. 
There is no requirement for additional 
information to be on these prescriptions beyond 
what is required for a UK prescription under the 
Medicines Act 1968. However if a specific brand 
name is specified then that must be supplied. 

Before deciding whether to dispense the item, 
you will need to consider whether the person who 
has signed the prescription is indeed a registered 
doctor or dentist in an EEA country or in 
Switzerland. You will have to make adequate 
checks - the web links for the regulators of these 
practitioners are available from the RPSCB - and 
to consider whether there may be language 
barriers if you need to query the prescription with 
the prescriber. 

If you feel you do not have sufficient 
understanding of the language in which the 

CPD Reflect • Plan • Act • Evaluate 

prescription is written, it may not be possible to 
dispense the prescription safely or to counsel the 
patient effectively. In this case all reasonable 
steps should be taken to try to assist the patient 
to get the medicine. 

Professionally you will need to be competent 
and recognise your duty of care to the patient as 
well as exercise your judgement in the patient's 
interests - code of ethics principles 1 and 2. In this 
case the patient is asthmatic and, while not 
actually suffering symptoms at the moment, he 
should have a salbutamol inhaler to provide 
immediate relief if he experiences an exacerbation 
of his condition. Principle 5.3 requires you to 
"recognise the limits to your professional 
competence and practise only in those areas you 
are competent to do so". Principle 7 requires you 
to take personal accountability for your own 
decisions, behaviour and work. 

Emergency supplies are allowed at the request 
of the patient (or the prescriber) for medicines 
previously prescribed by an EEA or Swiss doctor 
(or dentist) so if you are convinced the patient 
needs an inhaler and feel this judgement is within 
your competence, you could take up this option. 
Ruth Rodgers, MRPharmS, PhD, senior/ 
clinical lecturer in pharmacy practice, 
Medway School of Pharmacy, Universities of 
Kent and Greenwich 

We and our clients have encountered practical 
difficulties in verifying whether a prescription has 
been written by an EEA doctor. These difficulties 
hinder the ability of pharmacists to dispense EEA 
prescriptions to meet patient needs. 

The RPSCB's Guidance Note, "A Practical Guide 
to Dispensing EEA and Swiss Prescriptions", 
contains web links to assist in checking 
registration details. However, many of these are 
simply links to the GMC website, which provides 
contact details (often postal) of the EEA 
registration body. When faced with an EEA 

prescription, it is impractical for a pharmacist to 
write or email the appropriate regulatory body to 
seek confirmation of the practitioner's registration 
status (and, indeed, when we have tried on behalf 
of clients, the regulator has not responded). 

In the above scenario, if the pharmacist were to 
use the Society's link he would be directed to (it 
would appear) the German equivalent of the BMA, 
not the GMC. 

Until there is a method by which pharmacists 
can check the registration details of all EEA 
doctors online there will be practical difficulties in 
allowing access to UK pharmacies for patients 
who have EEA prescriptions. 
Noel Wardle is a solicitor with Charles Russell 
LLP, specialists in pharmacy law 

More dilemmas are online at www.chemist 


PLEA is an association of 
pharmacists interested in 
law and ethics, and lawyers 
or ethicists specialising in 
pharmacy, with the aim of promoting 
understanding of the ethical basis for 
professional judgement 

20 Chemists-Druggist 29.05.10 

A single step forward in BPH management 


Combodart, offers rapid, sustained and superior 
symptom improvement, with significant reductions in 
Acute Urinary Retention and BPH-related surgery vs 
tamsulosin in one capsule, once a day u 


(dulasteride /tamsulosin HCI) Capsules 

Discover the difference 

kombodart Fixed Dose Combination 

15 mg dutastende and 04 mg tamsulosin hydinchlonde iliaid capsules) Uses Die 
'eaiment of moderate to severe symptoms of benign prostatic hyperplasia (BPH) 
.eduction in the risk of acute urinary retention (AUR) and surgery in patients with 
lodetate to severe symptoms ol BPH Dosage and administration (Adults including 
Iderly) The recommended dose of Combodart is one capsule (0 5 mg/ 4 mg) Wen 
(ally appronmately 50 minutes attei the same meal each day, Die capsules should be 
wallowed whole and not chewed oi opened No dose agistment is necessary in the 
Iderly Caution is patents with mils lo moderate hepatic in payment In patient, with 
ewe hepatic impairment, the use of Combodart is coiiltaindicated. Wlieie appropriate, 
Combodart may be used to substitute concomitant dutastende and tamsulosin 
ivdiocliloride in easting dual therapy to simplify treatment Where clinically appropriate, 
lired change trom dutastende or lamsulosm hydrochloride monotherapy to Combodart 
may be considered Contra-indications Use in women, children and adolescents Known 
lypeisensiliyity to dutastende, other 5-alpha leductase inhibitors, tamsulosin (including 
amsulosin- induced angio-edemal or any ol the excipients Patients with a history ot 
irthostatic hypotension Patients with severe hepatic impairment Special Warnings and 
'recautions Combodart should be prescribed alter careful benefit risk assessment due to 
he potential increased nsl of adverse events and alter consideration ol alternative 
raiment options including monotherapies In a 4-yeai clinical study, the incidence of 

ongestr/e cardiac lailurel was higher among sublets taking the combination of 
lutasleude and an alpha blotter lamsulosm, lhan il was among subjects not fating the 
ombmation Ho causal relationship between dutastende (alone or in combination with 
in alpha Mocker) and cardiac failure has been established Digital recta! eiamination, must 
le performed on patients with BPH prior to initialing therapy with Comhndart and 



Mediately with soap and water Use with caution in patients with mild to moderate 

by approximately 50% after 6 months in patients with BPH, even in the presence of 
prostate cancer Iheiefore in palients treated (or sin months or mote, PSA values should 

in PSA levels while on Combodart should be carefully evaluated The ratio ol tree ro total 
PSA remains constant even under the influence ot Combodart II electing to use percent 

ad|ustment to its value appear, necessary The treatment of severely renally impaired 
patients should be approached with caution as these patients have not been studied As 

tamsulosin, as a result ol which, taiely, syncope can occut Patients beginning treatment 
with Combodart should be cautioned to sit oi lie down at the list signs of orthostatic 
hypotei ' imp! I live Flo| 

been observed during cataract surgery in some patients on oi previously treated with 
tamsulosin This may lead to mcK-ased pun edural complications doing the operation The 
nation ol therapy wil 

is therefore nor recommended Interactions There have been no drug interaction studies 
fa Combodatl Dutastende In vitro studies Dutastende mainly eliminated via 

administered orally) may increase serum concentrations ol dutastende No effect on the 
pharmacokinetics ot waitann, Jigoxin, lamsulosm oi terazosin Tamsulosin 
. : 

blood pressure, including anaesthetic agents and other alpha-l adieneigic blockers could 
/potensive effect I be used 


dulasteiide-larnsulosm is used in combination with cimetidme Caution should be 


nleiaelions at the levi 

liver microsomal fractions, involving amitnptyline, selbutamol and glibenclamide 

Diclofenac howevei, may increase the elimination rate of tamsulosin Pregnancy and 
lactation Combodart is contraindicaled in women There have been no studies to 
investigate the etled ol Combodart on pregnancy, lactation and fertility fertility 
Dutastende r!-;».'Vi • semen cbaradeistcsneduction n spems count, :emer 
volume, and speim motility) in healthy men Possibility ot reduced male fertility cannot be 
excluded Tamsulosin Effects ol lamsulosm hydrochloride on sperm counts « sperm 
function have not been evaluated Pregnancy Dutastende Small amounts ot dutastende 
have been found in semen ol subjects receiving dutastende 5 mg As with all 5-a!pha 
leductase inhibitors, a condom is recommended tot use in patients when then partner is 
or may potentially become pregnant to avoid exposure to semen Jmsulosm 
Administration ot tamsulosin hydrochloride to pregnant lemale rats and rabbits showed 
no evidence ot loelal harm Lactation Not known whether dutastende oi lamsulosin is 
■ v : Effects on ability to drive and use machines '. m- 

the effects of Combodart on the ability to drive and use machines have bee 
Howevei, patients should be informed about the possible occurrence ol symptom, related 
to orthostatic hypotension such as dizziness when taking Combodart Side effects Tre-e 
have been no therapeutic clinical trial; conducted with Combodart, howevei 
bioeguivalence ot Combodart with co-administeied dulasteride and tamsulosin has been 
■ s M redudion en Crux was observed tor the lamsulosin component in 
the ted state compaied to the lasted state Food had no effect on AUC ol tamsulosin 
Dutastende monotherapy clinical trials Higher incidence with dutastende than placebo 
groups Impotence, altered (decreased) libido, ejaculation disorders, breast disorders 
(including breast enlatgement and/or breast tenderness) Post marketing reports Allergic 
readion; including rash, pruritus, urticaria, localised oedema and angioedema 
Dutastende in combination with the alpha blocker tamsulosin • 4 year clinical data 
(CombAT) Highet incidence in the combination therapy group tn the tirst year ot 
treatment due to highei incidence ol reproductive disorders, specifically emulation 
disorders Other lepiodurtive disorders Impotence, altered (decreased) libido Breast 
liac fa 

CombAT 4 yeai BPH study, the incidence ot the composite term cardiac failure in the 

combination group was highet than m enter monotherapv group and similar to the sum 
ol the two different types ol therapy Legal category POM Presentation and Basic 
NHS cost Combodart 5 mg dulasteride and 04 mg tamsulosin hydrochloride lhaid 
capsules! £19 80 per 30 capsule pa:i Produd licence number 19494/0046 Produd 
licence holder GlaxoSmithKline UK ltd, Stoclley Part West, Middlesex, UB1 1 IBT 

Prescribing information updated April 2010 


Adverse events should be reported. Reporting forms and information 
can be found at www.yellowcatd Adverse events should also 
be reported to GlaxoSmithKline on 0800 221 441. 

wmai Date ot preparation April 20 iO 


The recommended dose ol Combodart is one capsule '0 5 mg' 4 mg) taken orally 

swallowed whole and not chewed or opened 

1 Combodart Summao/ ol Produd Characteristics. 2010 

2 RoehibomCGefal Eur Urol 2010, 57 123-131 







17 MUR cases ^ 19 Prescribing 20 Euro Rxs "W 22 Work safety p 26 Design awards |> 29 Away days 

Health and wellbeing at work is important for both employees and pharmacy businesses - without healthy happy staff, customer service is likely to 
suffer. Over the coming months C+D will be giving you guides and tips on improving your wellbeing, covering everything from boosting morale in the 
dispensary to your legal rights. If there is a health and wellbeing issue you would like us to cover, 


Accidents will happen 

Would you know what to do if the worst happened? Zoe Smeaton explains how 

to prevent accidents in the pharmacy - and how to cope if they do occur 

What to do if you have an accident at work 

1. Report it to someone in authority at your organisation 

2. Record any injury in the accident book as soon as 

3. If you need to, make sure your employer has 
reported the accident to the HSE 

Hit, 4. Check your contract or written statement of 

employment for information about sick or 
accident pay 

5. If there's a dispute, try to sort it out 
L with your employer 

6. If you still have problems 
|n> contact the HSE Infoline 

0845 345 0055 


nything can happen in a pharmacy," 
says David Reissner, head of 
healthcare at law firm Charles Russell. 
Although accidents might seem unlikely - things 
can and do sometimes go wrong in dispensaries, 
he reveals. From trips and falls to needlestick 
injuries, there are many ways in which 
pharmacists can come to harm. 

And although the government's Health and 
Safety Executive (HSE) says health and safety is 
primarily the responsibility of employers, it 
stresses that workers have a legal responsibility 
too. And, perhaps more importantly, it says 
workers who contribute to health and safety 
at work are safer and healthier than those who 
do not. 

Janice Perkins, superintendent at the 
Co-operative Pharmacy, agrees: "It is the 
responsibility of all colleagues to work in a way 
that protects both customers and co-workers so 
that a positive attitude towards health and safety 
is adopted throughout the business." 

So how can you help make your pharmacy a 
safer place to work in? 

Pr@vsiitQ.tivG msctswrss 

Your employer has a duty to protect you and to 
provide health and safety training, so the first 
thing you should do is to make sure you pay 
proper attention to this and are aware of the risks. 
Try to apply any training to your own dispensary, 
considering how specific working processes could 
be adapted to make them safer. You could also 
check there are adequate first aid equipment and 
facilities and precautions against fire. 

Think about the type of accidents that could 
happen in your pharmacy. The NPA says falls are 
common, with boxes left in walkways and wet 
floors commonly cited as factors. 

Ms Perkins adds: "Some of the most common 
accidents at work involve slips and trips, but 
these can be avoided if people are observant, work 
in a tidy and organised way, wear suitable 
footwear and remove any obstacles that may 
cause a fall." 

With the expanding clinical role of pharmacists, 
there may also be some additional risks creeping 

in. As Bruce Dixon, head of health, safety and 
environment at Lloydspharmacy, explains: "As it is 
a healthcare environment, there is always a risk in 
pharmacy, albeit very low, of a more serious 
accident occurring, such as needlestick injury. 
Despite the low incident rate, Lloydspharmacy is 
continually raising awareness of this risk and 
preventing needlestick injury is the current health 
and safety focus for the company." 

However, if you carry out your own risk 
assessment you'll be able to identify the risks 
and you can then work on ways to minimise 
them. You might need to talk to your employer's 
health and safety advisor or team about this so 
they can help improve practice, and if they aren't 
being helpful you can always contact the HSE 
without fear of getting into trouble if you still 
have concerns. 

With all the prevention in the world, though, 
sometimes things will still go wrong. So what 
should you do if an accident does happen? 

When accidents happen 

The first thing to do after an accident occurs and 
any injuries have been dealt with is to report it 
to someone in authority at your company. This 
could be your immediate line manager, the 
pharmacy manager, or possibly the proprietor if 
it's a small business. 

Then an entry should be made in the accident 
book as soon as possible, Mr Reissner says. As 
well as giving you a record of the incident 
should you need it at a later date, this also helps 
to maintain health and safety standards. As 
charity Pharmacist Support says: "It means 
that you're allowing the employer to maintain 
their duty of care to employees. By being 
informed of any issues you are enabling them 
to take any measures necessary to avoid a 
recurrence in the future, making the environment 
safer for everyone." 

Many companies will have formal accident 
reporting and recording processes for you 

22 CI 



intensive rescue 
moisture locking 
cream ^ fV 

^allergenic S^unfrag^^ ^ 

Moisture Locking Cream 

Vaseline Intensive Rescue has introduced its new Moisture Locking Cream 
to complement the existing products in its range specially formulated for 
dry and very dry skin. 

Vaseline has 1 40 years of skincare expertise, and the Vaseline Intensive 
Rescue range has been designed by the brand's scientists, who are 
experts in the causes and management of dry skin. 

Several factors can contribute to dry skin. Everyday use of soaps and 
detergents and dry environments such as winter weather, central heating 
and air conditioning remove essential lipids from the skin, reducing the 
effectiveness of the skin's barrier. 

To bring dry skin back to health and keep it healthy, it is important 
that skin is moisturised regularly. As well as water, there are three key 
ingredients that can work together to help keep dry skin healthy. 

Humectants e.g. glycerin 

• Maintains and instantly increases water content in the skin 

• Replaces lost natural moisturising factors and helps skin cells to 
retain moisture 

• Helps keep skin cells soft, pliable and elastic 

• Improves the visual appearance of the skin 

Occlusives e.g. petrolatum 

• Replaces lost lipids in the skin 

• Provides a barrier to water loss through the skin 

• Helps protect the skin from the environment 

Emollients e.g. dimethicone 

• Spreads easily on the skin 

• Provides partial occlusion that hydrates the skin's appearance and feel 

• Contributes to the flexibility, softness and smoothness of skin 

Not all moisturisers are as effective as each other. The right combination 
of ingredients is required to help skin repair itself and Vaseline Intensive 
Rescue Cream is formulated to provide twice the moisture of E45 
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of effective, active moisturising ingredients to provide instant relief and 
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In order to moisturise the skin effectively, different parts of the 
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Moisture Locking Cream has a new rich and 
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well as on dry patches. 250ml: RRP £3.99 

Moisture Locking Body Lotion increases moisture 
reserves instantly to lock in moisture all day, promoting the 
ideal environment for dry skin to repair itself. 
200ml: RRP £2.99, 400ml: RRP £4.99 

Lightly Fragranced Moisture Locking Body Lotion has 

all the benefits of the lotion and a light, clean fragrance, 
which makes it so pleasing to use that people with dry skin 
will enjoy applying it every day. 
200ml: RRP £2.99, 400ml: RRP £4.99 

II Relief and Repair Balm is perfect for frequent application 
£3 to dry skin trouble spots. It works within seconds to relieve 

severe dryness. 

100ml: RRP £4.99 

Soothing Hand Cream has a cationic formulation that 

provides instant hydration without the stickiness of most 

hand creams. 50ml: RRP £3.39 I 

p— 5 Hydrating Foot Cream is a fast absorbing cream 
formulated with AHAs to help promote exfoliation and 
soften dry, cracked heels. 

Vfl 50ml: £3.39 RRP 

Reteienuj I After two wneks ba..ei:i nucirneometie cljtj 

For more information and to 
samples of Vaseline Intent 








17 MUR cases 4 19 Prescribing 4. 20 Euro Rxs W 24 Work safety ^ 26 Design awards (► 29 Away daysl 

A ^ 

Carrying out a risk assessment in the pharmacy makes it possible to devise ways to minimise them 

to follow and to help them learn from incidents. 
The Co-operative Pharmacy, for example, has an 
online reporting tool that transmits details of 
incidents to their health and safety team, and at 
Lloydspharmacy accidents are reported to head 
office, also via a back office electronic accident 
reporting system. 

If you have had a serious accident, your 
employer is required to notify the HSE and inform 
their insurer, so you should also check they have 
done those things when you can. In such cases you 
may need to take time off work or even claim for 
compensation if the accident was not your fault. 

If you do need time off because of your injury, 
you should be getting statutory sick pay and you 
might even be able to claim benefits to boost your 
income when you are off work or when you go 
back to work. There may also be measures in place 
to help you if you have to stay off work following 
an accident. The NPA says its employers' liability 

insurance provides for funding rehabilitation in 
appropriate circumstances, to help people return 
to good health and work as soon as possible 
following an accident. And as Mr Dixon says: "If 
we can assist an employee back to work then we 
will refer them to our medical rehabilitation 
partner. If a colleague has been involved in an 
accident that has caused them some distress, then 
we will make an offer of counselling to help them 
through this difficult period." 

If the accident was not your fault and your 
employer has been negligent or in breach of a 
statutory duty, then you will be able to make a 
claim against them. This is where your employers' 
liability insurance, which all employers are legally 
required to have, will kick in. Mr Reissner advises: 
"If an accident is down to the fault of the 
employer, as sometimes happens, then the 
employee should write to the employer. The 
employer should then ensure that they promptly 
pass any complaints to their insurers." 

Mr Reissner says in practice the insurance 
company will then take over the handling of any 
claim, dealing directly with the employee. This can 
make it easier for everyone involved, especially if 
the employee and employer are still working in 
the same place, he says. 

You might need a solicitor to make a claim like 
this, or you could try seeking support from the 
Pharmacists' Defence Association or contact the 
HSE yourself. You can also contact Pharmacist 
Support, who can give information and provide a 
referral for specialist advice on employment law 
and benefit entitlement. 

Happy birthday! 

celebrate its 1st birthday 
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Major employers' 
accident policies 

"As a business we undertake regular risk 
assessments and branch audits to ensure 
staff are complying with HSE recommended 
guidelines to minimise any potential risks to 
staff and any other individuals who are on 
the premises. We have a detailed health and 
safety manual for employees to follow. In 
addition to this we provide e-learning 
modules to educate pharmacists and branch 
staff about when and how they should 
report an accident if one occurs." 
Janice Perkins, superintendent, 
The Co-operative Pharmacy 

"Forming part of our overall health and safety 
policy we have procedures for accident 
reporting and investigation. Our teams are 
instructed to report all accidents, no matter 
how minor, to their line manager. This is in 
order that it may be investigated, the cause 
established and any action to prevent it 
occurring again implemented. And despite 
the low incident rate, Lloydspharmacy is 
continually raising awareness of the risk of 
needlestick injury - preventing it is the 
company's current health and safety focus." 
Bruce Dixon, head of health, safety and 
environment, Lloydspharmacy 

"Boots UK has health and safety officers and 
policies in place to ensure our people are 
safe at work." 
Spokesperson, Boots UK 

CPD Reflect • Plan • Act • Evaluate 

Tips for your CPD entry on safety at work 


Can I make my pharmacy a safer 
place to work? 

PLAN Identify potential accident risks 

ACT Raise risks and possible 

preventative measures with health 
and safety managers 

EVALUATE Have new measures made the 
pharmacy safer? 


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4 17 MUR cases 4 19 Prescribing 20 Euro Rxs 4 22 Work safety 26 Design awards ► 29 Away days 



From Sir Norman Foster's 
Gherkin to the iconic 
Wembley Stadium, great 
design is all around us. 
As the winners of this 
year's Platinum Design 
Awards demonstrate - 
cutting edge design can 
be found pharmacies too. 
Hannah Flliyjmnrn mpori^ 

Meet the design 

Robotic dispensaries, three-tier 
dispensing bench systems and 
touchscreen technology were all used 
by the winners of this year's C+D's Platinum 
Design Awards in association with Ceuta 

At the awards ceremony, held last week 
in Marylebone Cricket Club's iconic media 
centre (which won a RIBA Stirling prize for its 
design), judges commented on the increasingly 
innovative techniques employed in pharmacy 
shopfitting design. 

Gary Paragpuri, C+D editor and chair of the 
judges, told the winners that the quality of 
pharmacy design had improved greatly in recent 
years, with more pharmacists keen to consider 
aesthetic impact. 

"Recent winners of the Platinum Design 
Awards have amply demonstrated how far 
pharmacy has developed. I am sure we can all 
remember when a few new shelves, a new carpet 
and fascia was considered a major upgrade; but 
this is a world away from the simply stunning 
efforts that we are here to celebrate today," he 
told the winners. 

The other judges were David Mair, chairman of 
awards sponsor Ceuta Healthcare; National 
Association of Shopfitters president Brendan Turtle 
and last year's overall winner pharmacy proprietor 
George Romanes. 

And the winner is... 

First prize went to Murrays Healthcare for its 
newly designed business at Malvern. Along with a 
cheque for £3,000, Murrays scooped the Best 
Multiple Pharmacy Award. 

The multiple's pharmacy in Malvern was put up 
in just five weeks, according to the company, and 
included the installation of a dispensing robot and 
a dispensing system involving three benches. 
Patients hand in their prescription at the first 
bench, drugs are dispensed at the second and the 
pharmacist checks and dispenses it at the third. A 
quick advice counter was also installed for patients 
who did not need to use the consulting room. 

One of the judges said: "[This is] a good 
business idea and well executed, providing a very 
attractive offering and seemingly good return on 

Murrays Healthcare managing director Duncan 
Murray said: "We are absolutely delighted to 
participate in the awards and to have won it. It's 
great to hear judges saying it could be something 
out of an art gallery, it is very important to us." 

The pharmacy was designed by BAPTT 

A close second, and winner of £2,000, was 
Sutherland's Pharmacy in Kirkwall, Orkney. 
Owner Torquil Clyde set out to design a new 

store built to offer new Scottish services, including 
the freshly finalised chronic medication service 
(CMS), and was adamant he would integrate the 
retail and professional elements of the business. 
One of the changes made was a robotic 
dispensary, which means pharmacists and 
technicians spend more time on the shop floor. 

Due to the offshore location of the shop, 
materials for the refit - designed by Anderson 
Retail Consultants - had to be shipped piece by 
piece to the site. The judges described the new- 
look pharmacy as "a sumptuous visual treat". 

On winning second prize, Mr Clyde said: "I think 
my staff enjoy working in the environment and 
they appreciate the effort we have made. It is a 
real uplift in our daily lives." 

Third prize 

Primary Care Pharmacy in Nuneaton scooped 
third prize and a cheque for £1,000. The company 
stated one of its objectives was to provide 50 
supervised consumption clients with dignity and 
without affecting other patients. Following the 
fitting of consultation rooms and installation of a 
Methameasure methadone dispensing system, it 
reports a significant return on investment. 

"Blood, sweat and tears have clearly been 
invested in this project," the judges said. "Definite 
wow-factor and the forward planning to include 
an internet pharmacy and a lobby area for out-of- 

26 Chemist+Druggist 29.05.10 

More pictures of the awards, sponsored by Ceuta Healthcare, can be viewed at: 

Muirays Healthcare's Duncan 
Hurray (top right) picked 
up first prize in the Platinum 
Design Awards, sponsored 
by Ceuta Healthcare, for the 
stunning Malvern Pharmacy 
(far left). Second place 
went to Torquil Clyde's 
Sutherland's Pharmacy in 
Orkney, and Michael Burr's 
Primary Care Pharmacy 
scooped the third prize 


hours dispensing shows a real understanding for 
future-proofing the business." 

The project's designer, John Hilditch of Dollar 
Rae, said: "You have to have a specific objective 
and that has to be right at the beginning. You need 
to focus on not just how it appears but that it is 
practical and functional and efficient." 

Superintendent pharmacist Michael Burr went 
on to say: "Obviously, the patients are free to go 
anywhere they like but a great design makes them 
willing to come to you and go back to you." 

Highly commended 

The quality of entries was extremely high and 
three pharmacies were awarded highly 
commended certificates: Lloydspharmacy in 
Epping, AE Hobbs in Tunbridge Wells, and MedicX 
Pharmacy in Blackpool. 

One of the USPs for Lloydspharmacy was its 
beauty section. So, when a merger of two local 
stores was proposed following a decline in sales in 
recent years, regional director Nicholas Hougham 
set out to create a new premium pharmacy model 
that would combine high end retail and services. It 
was designed by Lloydspharmacy 's in-house 
design team. 

At the awards, Mr Paragpuri said: 
"Lloydspharmacy 's Epping branch is a stunning 
example of great design on the high street." 

Lloydspharmacy senior pharmacy designer 

Darren Cotton said: "We needed to figure out how 
to optimise our business and our returns on our 
investment by moving into different channels that 
perhaps we haven't worked in before." 

AE Hobbs was also highly commended by the 
panel for a refit three years in planning. 

Mr Paragpuri said: "The beautiful wood finish, 
the gorgeous red logo and the curved finishes all 
add up to a truly impressive-looking pharmacy 
and a fabulous example of how good independent 
pharmacies can be." 

Contractor Chee Ming Majoe said he contacted 
designer Keith Anderson, of Anderson Retail 
Consultants, following a C+D article on the 2008 
Platinum Design Awards winner. 

"What he did for us was superb," Mr Majoe said. 
"He actually thought outside the box and, 
[compared to] the two or three I called in before 
who very much went down a particular route, he 
thought of details I hadn't thought of before." 

MedicX Pharmacy, which has been open less 
than a year, was highly commended by the judges. 
It was designed by MIP Design. 

The judges said: "[It is] cracking, cutting edge 
design that uses colour, layout and open space to 
create a visual delight." Operations manager 
Gavin Birchall said: "The MedicX Pharmacy vision 
has been focused on making an environment the 
patient is happy to be in, and I think it can have a 
strong overall impact on a patient's health." 

CPD Reflect • Plan • Act • Evaluate 

Tips for your CPD entry on pharmacy design 

REFLECT Does my pharmacy present a 
professional image and support 
work processes? 

PLAN Consider how a refit or smaller 
layout changes could improve 
image and work processes 

ACT Implement refit or layout changes 

EVALUATE Have public image and workflow 

29.05.10 Chemist -Dru, 



C+D Jobs celebrates 7,094 unique monthly users 

'Jan-Mar 2010 average Omniture recorded stat 

0207 921 8123 

Booking and copy date 
12 noon Monday prior 
to Saturday publication 
subject to availability 

Contact: Andrew Walker 
Tel: 0207 921 8123 
Fax: 0207 921 8132 

Ludgate House 
245 Blackfriars Road 
London SE1 9UY 

Lancaster, Rawtenstalt, Wigan, Leigh, Southport, Accrington & Farnmouth 

When you re in-store, you can do more. When you're not tending to our customers' medical woes you could be dispensing advice 
on healthy diet. In-store means in touch, in control, and right in the heart of the local community - developing your pharmacy, your way, 
every day. For more information and to apply visit 

We respect all our colleagues and value their differences We do not tolerate any form of discrimination or harassment 

and be your 
L Hero. A 

You'll be touching all areas of your local community. 
Last year we completed 1.5 million healthy heart 
checks and this year we are even more committed to 
providing community based healthcare services. So 
whether you're taking a customers blood pressure or 
helping people to alter their lifestyles, you will be part 
of a company that's committed to Healthcare for life 
at a national level. 

Join us to make a real difference to people's everyday 
lives, and help us to shape the future of healthcare. 

We are currently recruiting 
newly qualified Pharmacists in 
the following locations: 

North East England, Yorkshire, 
Lancashire, Greater Manchester, 
North Wales, Lincolnshire, Staffordshire, 
West Midlands, Kent, West Sussex, 
Oxfordshire, Devon, Cornwall, Somerset 
and Gloucestershire. 

In return we will offer you a competitive salary, 
payment of your RPSGB fees, company pension 
scheme, bonus scheme, private medical cover, interest 
free loan, overtime, CPD study leave, and optional 
benefits (such as buying additional holiday entitlement). 
To apply please email your CV and a covering note 

For a confidential discussion please call a member 
of the Resourcing Team on 0800 917 8870. 

For further information visit 


Healthcare for life 



Excellent rates for the right candidates. 

or call 0208 2566 222 

day lewis 



Enthusiastic Pharmacists required to manage and provide the full range 
of services in our established and well supported branches within the 
Oxfordshire and Bedfordshire areas. 
Send your CV by email: 

or call on. 01582 560393 


28 ruwisi 29.05.10 


, 17 MUR cases 19 Prescribing 20 Euro Rxs ' 22 Work safety 26 Design awards 29 Away days 


Get away from it all 

After C+D revealed stress levels in the sector are still soaring, 
Zoe Smeaton finds a team away day could be just the thing 

hen the pressures 
of working in the 
dispensary get on top 
of you, the last thing you may want 
to talk about is work. Relaxing away 
from the pharmacy and trying to 
forget all about it is probably high 
on the agenda, so you might not 
consider spending more time with 
your colleagues. But actually, 
getting to know the people you 
work with could be just the thing to 
help improve your daily life and kick 
start your climb up the career ladder. 

A useful way to spend time with 
colleagues is to organise an away 
day. This could be anything from an 
afternoon walking the hills, to a trip 
to your favourite local restaurant or 
even organising a structured away 
day through an outside organisation. 
A quick online search reveals a 
myriad of options offering 
everything from days on team 
building or conflict resolution, to 
trying to prepare for new projects or 
work on mission statements. 

Deciding what you want to 
achieve on your away day is 
important, says Yvonne Tuckley, 
Numark's training manager. "You 
need to be clear why you are having 
an away day in the first place - is it 
essentially a jolly, or to enable 
people to learn something, or is it 
team building 7 As with anything 
else, you need to have an objective 
in mind " 

And there are lots of options 
Although planning strategies and 
projects might seem a million miles 
away from the dispensary, they 
could apply, for example, if you were 
preparing to launch a new service. 
Sitting down with colleagues to plan 
what you want to achieve and how 
you will manage it in the dispensary 
could be a useful exercise and help 
get everyone motivated. Getting it 
right from the beginning could make 
all the difference in making it a 
success, which will be good for 
patients, the pharmacy and, of 
course, your own career. 

Perhaps a more likely option in 
pharmacy is to concentrate on team 
building This does need to be 
planned properly, to ensure people 

Rowlands Pharmacy head office staff recently tackled five community projects 

will be at their best and so are more 
likely to get along, but it can bring 
many benefits. Asda superintendent 
pharmacist John Evans says it can be 
useful to get to know your 
colleagues better. They might, for 
example, then offer you more 
support on the tough days at work. 
Oryou might get to know someone 
senior, who could offer career help 
and advice. 

Suggesting an away day to your 
employer in the right way could also 
help your career - if they see you're 
doing it for the right reasons because 
you're enthusiastic about developing 
yourself and about making the 
pharmacy run as smoothly and 
efficiently as possible, they're likely 
to appreciate your approach. Boots, 
for example, is a supporter of the 
strategy, saying it has been offering 
employees community-based team 
challenges for over 10 years "as an 
opportunity for colleagues to spend 
time together as a team while giving 
practical support to the local 
community". The multiple says such 
events can help raise morale but also 
provide personal development 

It's also worth considering that 
taking on the task of arranging a 
team day will require you to 
demonstrate organisational and 
other skills that could get you more 
brownie points from your employer 
Boots works with charities to 
arrange its staff opportunities and 
says each day has a team leader. 

"The nominated team leader will 
liaise with the account manager 
at the charity to co-ordinate the 

team challenge. We encourage the 
team leader role to be taken on 
by a more junior member of the 
team as a development opportunity 
to demonstrate leadership and 
organisational skills," Boots says 

If you're having trouble arranging 
an away day, remember that it 
doesn't have to be a full day away 
from the dispensary, which can be 
hard to find time for. You could try to 
find time outside of work or just go 
for a few hours. You might even be 
able to go somewhere work-related, 
which would help show extra 
enthusiasm for your job. For 
example, Ms Tuckley suggests going 
to an event like the Pharmacy Show 
or the C+D Awards together. 

Whatever you choose to do, 
though, as long as you're proactive 
about it and try to take positives 
from it, there's every chance your 
away day could help both your 
everyday working life and your 
career. As one Boots employee 
concluded after a team day: "The 
team really enjoyed the day and the 
preparation that went in to it. 
Although it was hard work it was 
worth it." 


Reading between the 
lines of a job advert 

The role: Community pharmacist at 
a Cornwall independent pharmacy. 
The location: Mostly based at a 
busy dispensary in a Newquay 
health centre, but with some work 
at the business's other non- 
dispensing pharmacy that is 
popular with tourists. 
The job: Usual dispensing activities 
plus delivering services such as 
smoking cessation, MURs and EHC. 
The patients: Regular patients of 
the health centre, rather than 
passing trade. 

Best bit: The administrative 
support The pharmacist will only 
be responsible for day-to-day 
paperwork, with the rest being 
completed by head office. As an 
independent, the employer also 
does not set targets for employees. 
You will need: Good organisational 
skills and lots of motivation to 
thrive in the busy dispensary. 
Only if you don't mind: Some 
Saturday work at the non- 
dispensing pharmacy. This role 
involves giving lots of advice to 
patients and making OTC sales. 
Upcoming plans: The business is 
open to suggestions on services or 
other developments, so any ideas 
you have could happen. 
People power: The pharmacy often 
has two pharmacists working 
alongside staff such as accredited 
checking technicians and dispensing 

Apply if: You're happy working for a 
family-run business with a friendly, 
sociable team. 

C+D was talking to Liz 
Nickels, director and 
company secretary of 
Drury's Pharmacy 

See the job advert on page 30 
and search for jobs at 

CPD Reflect • Plan • Act • Evaluate 

Tips for your CPD entry on pharmacy team building 

REFLECT Does my pharmacy team work well together? 

PLAN Consider if an away day could improve teamwork, and 
therefore patient service 

ACT Organise an away day or team outing, with goals in mind 

EVALUATE Did activity improve team morale and has this benefited 
patient service? 

29.05.10 29 



We are looking for an enthusiastic full time dispenser/ 
dispensing assistant to join our team in this busy, friendly 
health centre pharmacy. Training will be provided if needed. 
The ideal candidate will be working closely with the complete 
health care team in order to deliver NHS service. 

Please apply with a C.V. to Beran Patel at 020 8689 7127 

Brigstock Pharmacy 
141 Brigstock Road 
Thornton Heath 
Surrey CR7 7JN 

■ - Jin J AY 


Full time position 

Busy independent pharmacy with minimal 
paperwork. Competitive Salary 
Private medical cover and pension 
contributions. RPSGB fees paid 

Drury's Pharmacy - 01637 872589 

CV to Liz Nickels 
1 Chester Road, Newquay TR7 2RT 
or email 

Over 14,700* applications since launch 

May 2010 Omniture recorded stat \# l^J^/U^ 

Pharmacy Manager 
Longlevens, Gloucs 

■ ! (^excellent + benefits + relocation) 

i Fantastic opportunities at heart of Community 
' pharmacy. 

Email your CV to 

or call on 02476 432983 

■ jl Pharmacy ^ 

PlaCe*> Recruitment 

by Pharmacists 

Pharmacy Manager - Shard End. 


- Spacious refitted community 
pharmacy with medium/busy 
dispensing volume 

- Great relationships with local surgery 

- Opportunities for services with a fully 
staffed dispensary team 

- Flexible working and 4-day week 

- Genuine market-leading salary - plus 
benefits and bonuses 

- Ideal candidate will have strong 
management experience and 
enthusiasm for services 
0161 429 6775 

Chard, Somerset 

(£excellent + benefits + relocation) 

: Fantastic opportunities at heart of Community 
: pharmacy. 

Email your CV to 

I or call on 02476 432983 



Quest 4 Locums Ltd 

has vacancies in Newcastle, 
Middleshorough, Manchester, 
Leeds, Kings Lynn from 
occasional days to block 
bookings for Locum 
Pharmacists in Community 
Pharmacies. The assignments 
are for immediate start and in 
the near future. 
or contact us at 
or mobile: «79KX 023642 

HANDBOOK 2009/10 

Your pocket guide to Locum Pharmacy Practice 

Part-Time Relief Pharmacists and Locum Opportunities 
available in: 

Suffolk/ Norfolk/Wiltshire/Hampshire Area. 
Attractive Salary and benefits package. 
For further information, please contact 

MSc in Community Pharmacy 

Do you have work or family commitments that make home study attractive? 

Queens University Belfast has been delivering postgraduate distance learning 
programmes for pharmacists for more than 20 years. These continuing 
education courses have been completed by over 2000 pharmacists in more 
than 25 countries around the world. 

Our distance learning format allows pharmacists worldwide to obtain 
a postgraduate qualification while in full or part-time employment. PG 
Certificate & PG Diploma awards are available 

Credit may be awarded for previous postgraduate courses. 

Our next programme will commence in October 2010. For further information 
and to apply, please visit our website, or contact the Distance Learning 
Manager, Brian McCaw: Tel: 028 9097 2004 

School of Pharmacy, MBC, 

Queen's University Belfast, £ 
97 Lisburn Road, 
Belfast, UK BT9 7BL 

QUB School of Pharmacy: 

The School of Pharmacy at Queen's is ranked as the Number 1 School of Pharmacy 

in the UK by the Times Good University Guide 2010. 

Queens University 


Queen's University Belfast is a member of the Russell Group of universities. 
One of the United Kingdom's top 20 research-intensive universities. 

Chemist+Drupsist 29.05.10 

Having trouble finding the right staff? 


0207 921 8123 

Contact: Andrew Walker 


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Cost effective specialist legal advice 
to independent retail and community 

We can assist with buying, selling, merging 
and demerging pharmacy businesses as 
well as related leases, sales and purchases 
of commercial premises 


————— Solicitors 

Hilary D'Cruz or Jas Singh 
01543 466 660 




on 01206 323808 or Mob 07920 476222 
E mail denis.olear v @pharmacybusinesstransfer. 


East Yorkshire 







If you are planning to sell your pharmacy 
you should be preparing for it now. 

Call us today for a no obligation confidential discussion: 
We can provide:- 

An up to date appraisal of the market 

R7l A free valuation of your pharmacy 

W\ A comprehensive list of information and 

documents you will need to provide to buyers. 

jvj Tips on how to achieve TOP price 

We look forward to receiving your call 

01494 722224 


"We are the only NPA 
approved supplier for 
selling your pharmacy" 

Hutchings Consultants Ltd 


(National Pharmacy 
Association M 

Approved Supplier 

29.05.10 Chemist Dm ,1 31 


unplanned e<vQns,w. 1 

IWarie Stopes International are experts in sexual 
and reproductive healthcare and work closely 
with the NHS to provide local services. 

If you would like leaflets about unplanned 
pregnancy, abortion, chlamydia, vasectomy or female 
sterilisation call us for a free sexual health pack. 

020 7034 2382 

female sterilisation . 


Are you Overstocked? 

Knights will help you sell your excess 


Check out our website - what can you 
offer us? 

Masfico is moving 

17 Colonial 
Watford WD24 

We are pleased to announce that Mashco is moving to a large, 
state of the art logistics centre in Watford. All of our offices and 
warehouse operations will be relocated. We hope to be fully 
operating there by June. . 

Our new address is 17 Colonial Way, Watford, WD24 4PT. 
:b and email address details remain the same. * email: 

1 - .* , 


Chemist+Druggist remains the clear leader 

in influencing stock decisions* 
*linda Jones Associates Industry Survey 2009 

Have you received your free listing? 



larmacy design and shopfitting 
without compromise 

t: 0845 450 5904 






Let employers come to you 


publish a CV 



As the leading tax consultants to retail pharmacists we 
have clients throughout the UK. 

We know many pharmacists are happy with their accountants 
but are not getting proactive tax advice. 

We have the answer. You don't need to change accountants 
- we can work alongside them solving your tax problems 
and advising you how to reduce your tax bills. 

Some clients like a total service provider - others like 
to keep their existing accountant and just use our tax 
consultancy services. 

"We are happy to work in the way 
that suits you" 

Call us NOW to discuss how we can help you? 
Phone Anne Hutchings on: 01494 722 224 

The Leading Tax Consultants 
for Retail Pharmacists. 

Maple House, 
53-55 Woodside Road, 
Amersham, Bucks 
HP6 6AA 


Hutchings & Co. 


Med way 
School of 

in partnership with 



Siptirrngbo i \ ' sngo nop mow 
forr fthe 201 0-1 i pire-reg 
traniMMiinig programme 

Springboard is a pre-registration programme offered by 
Medway School of Pharmacy in partnership with C + D. 
Springboard equips pre-registration students with the skills 
and confidence to ensure a smooth transition from pharmacy 
graduate to practicing pharmacist. 

The pringhoHn pre-registration training programme consists 
of eight study days facilitated and delivered by staff from C+D 
and Medway School of Pharmacy covering a wide variety of 
topics, enabling students to meet the appropriate competencies 
in the RPSCB's student handbook. 

Springboard is unique in that by the end of the course the 
students will have also completed an accredited medicines 
use review training programme, the C+D Counterpart 
pharmacy assistant course, the Practice Certificate in Pharmacy 
Management course, as well as receiving a subscription to an 
online practice exam question website. 

Springboard also includes a training day for the 
pre-registration tutor. 

The cost of Springboard is from £1,200 (+ VAT) per student. 

For more information phone 0207 921 8413 
or email 




modiplus provides the following 
compliance services at a fixed price: 

" Preparation of annual accounts 

8 Preparation of tax returns 

" Filing accounts and returns with the HMRC 

and Companies House 
:: Ensuring your accounts and tax returns are filed on time 
:: Registering you with the HMRC for 

self-employment status 
8 Help you with the purchase of pharmacy 
• : Ad hoc email and telephone advice 

with our friendly staff etc. 

I am very happy to have an accountant who 
is a locum specialist. By going into company, I have 
saved tax and the savings I made in the first year 
more than covers the accountant's fees. ^ y 


For more information or for a 
FREE consultation please call Sangeeta 

on 020 7383 3200 " 

P™ modi pluso 





Got a story for Postscript? 

Rowlands celebrates 200 years of service 

To mark Rowlands' 200th anniversary, Postscript takes a look back at how the 
chain has grown over the past two centuries and what lies in store for the future 

It all began 200 years ago, during the reign of King 
George III (the mad one), when the first Rowlands 
pharmacy branch opened in High Street, 
Wrexham, North Wales. 

The business branches out and a second store is 
opened in Ruabon, near Wrexham. 

One hundred years after the first store opened, 
and the Rowlands family has become a local 
institution. Leonard Rowland was the Mayor of 
Wrexham throughout the First World War and 
was knighted in 1920, while Mary Rowland was 
awarded an OBE. 

^AkC-H b, 1911. 



, h[V d ,d „. *. rlS"^ trtU comes FIRST. 

M0ML -.-----'-'r^«- CLEANLINESS. 


Always a hard-working group, a total of 25,562 
prescriptions were dispensed in January and 
February 1931 alone . 

Rowland Cole, several times great-grandson of the 
founder Edward Rowland, joins the company. He is 
pictured with his son, right, during an interview for 
the Daily Telegraph in 1989. 

1 91 

Local paper the Daily Post features the 
pharmacies, quoting Langshaw Rowland as saying: 
"I opened the shop at 8.30am to 9.00pm in the 
week and to midnight on Saturday. 

"Prior to that it was 6am opening in the summer 
and 7am in the winter." 

By now the chain has 245 employees and 14 
branches. The company also diversifies, with 
Humphrey Rowland starting the multiple's 
wholesale business in Wrexham. 

Rowlands has 505 community pharmacy 
branches located across the UK. May also sees 
Rowlands open its first nursing and mobility shop, 
offering a more specialist range of equipment 
to complement the products stocked by its 
pharmacy branches. 

is your pharmacy celebrating a milestone this 
v/.? i Posts* ripl I now what you're up to 

A word from the MD 

"Rowlands is proud 
to be celebrating 
200 years of 
providing pharmacy 
services in the heart 
of local 
around the UK," 
says Rowlands 
managing director 
Kenny Black. 

"Our success can 
be attributed to our 

loyal, hard working and dedicated staff who 
know our customers and understand local 
health needs. In the last two years alone we 
have celebrated many long service awards with 
our branch staff and seen 14 teams and 
individuals gain awards at national pharmacy 
events, in honour of their achievements. 

"Moving into 2010, we will build on our 
existing solid foundations of patient care and 
maintain our community focus. We will 
continue to invest in staff development and 
peer-led learning and utilise our simple, but 
effective, team approach to empower our 
staff to use their skills and talents to serve 
our customers. 

"We already have an online staff forum and 
in June this year we will have our first staff 
conference, attended by two staff from each 
of our 505 pharmacies. We will use the 
opportunity to provide feedback from different 
areas, share ideas and support future plans for 
the business. 

"I believe this approach will allow us to 
sustain and develop a successful pharmacy 
business. The team approach has worked for 
the last 200 years so why change a highly 
successful formula!" 

From top: an article about Rowlands in The Leader 
newspaper from 1931; an advert proudly declares the 
number of prescriptions dispensed by Rowlands in 
January and February of the same year; Rowland Cole 
and his son get down to business with The Daily 
Telegraph in 1989; while Rowland the Owl prove a big 
hit in the community in 2010 

34 Chemist+Drueeisi 29.05.10 



I i 

Accredited by 
the RPSGB 



Counterpart is an accredited training course for medicines 
counter assistants. Staff will work through a series of 1 k 
learning modules covering different therapy areas. The 
learning modules can be shared with colleagues making the 
course the most economical on the market. A telephone 
marking system means staff will get instant results when 
they complete each module. 

Written by a team of experienced community pharmacists, 
Counterpart will equip your assistants with the knowledge 
required to recommend and sell medicines safely and 

lb register your staff, call 0207 921 8425 or vfs1t 

Supported by 


(excl Private Lab 

in 1 1 ! 1 1 1 

For short term treatment of acute moder 
not relieved by paracetamol, ibuprofen or aspirin alone 

Can cause addiction. Use for 3 days only. 

Product Information: Solpadeine Max Soluble Tablets. Presentation: Paracetamol 500 mg, Codeine Phosphate Hemihydrate 12.8 mg and Caffeine 30 mg. Uses: Short term treatmen 
of acute moderate pain not relieved by paracetamol, ibuprofen or aspirin alone. Dosage and administration: Dissolve in water before taking. Adults and children, 12 years and over: Two! 
tablets up to four times daily. Not more than 8 tablets in 24 hours. Children under 12 years: Not recommended. Do not take for more than 3 days without consulting a doctor. 
Contraindications: Known hypersensitivity to ingredients. Precautions: Can cause addiction. Use for 3 days only. Renal or hepatic impairment, non-cirrhotic alcoholic liver disease. Sain 
restricted diet. Sufferers from persistent headache and withdrawal symptoms should consult a doctor. Interactions: Warfarin or other coumarin anticoagulants, domperidone, metoclopramide, 
colestyramine, monoamine-oxidase inhibitors, mexiletene. Pregnancy/lactation: Do not use without medical advice. Side effects: Paracetamol: rarely, hypersensitivity including skin rash; 
very rarely, reports of blood dyscrasias (not necessarily causally related). Codeine: constipation, nausea, vomiting, vertigo, difficulty with micturation, dry mouth, rashes, urticaria, dizziness, 
drowsiness, restlessness and irritability. Legal category: P. Product licence number: 00071/0234. Product licence holder: GlaxoSmithKline Consumer Healthcare, Brentford, TW8 9GS, 
U.K. Package quantity and RSP: 16s £3.49, 32s £5.89. Date of last revision: January 2010. Solpadeine is a registered trade mark of the GlaxoSmithKline group of companies. 

' Source: Neilsen: Total Chemists MAT Value & Unit Sales (11.12.09)